Ultrasound findings may predict risk of future gout flares

Baseline monosodium urate (MSU) deposits and inflammation identified by ultrasound (US) are independent predictors of gout flare-ups during a 12-month period, says an article published in Rheumatology Journal.

Gout flares are a defining characteristic of the condition and a key aspect of how patients feel the condition. Gout flares are also a clinical sign of disease severity, are included in the 2016 preliminary remission criteria for gout, and are supported by the OMERACT as a primary outcome area in clinical studies. Edoardo Cipolletta and colleagues carried out this investigation in order to determine whether US results suggestive of MSU deposits and US-detected inflammation predict the incidence and the frequency of flares over the course of 12 months in gout patients.

In this prospective, observational, single-center trial that lasted 12 months, gout patients who had been receiving urate-lowering treatment for at least the previous 6 months were included sequentially. There was a nested case-control analysis. Cases were individuals who self-reported at least one gout flare throughout the follow-up period, whereas controls did not. The first MTP joints, knees, ankles, wrists, second MCP joints, and elbows were all assessed in the US. The MSU deposits were classified as present or missing in the US results using the Outcome Measure in Rheumatology criteria.

The key findings of this study were:

1. 81 people with gout were recruited, and 71 of them finished the research.

2. A median of 2.0 flares were experienced during the course of a year by thirty (42.3%) of the 71 patients.

3. At baseline, cases showed a higher US load of MSU deposits and a stronger Doppler signal than controls.

4. In multivariate analyses, the incidence and frequency of flares over a 12-month period were substantially correlated with baseline US scores showing MSU deposits and US-detected inflammation.

In this tiny experiment, ultrasound results were indicative of future gout flare-ups. Understanding the significance of ultrasonography in clinical practice, such as identifying individuals more likely to benefit from prolonged courses of anti-inflammatory prophylaxis, would require additional study in this field.

Reference: 

Cipolletta, E., Abhishek, A., Di Battista, J., Grassi, W., & Filippucci, E. (2022). Ultrasonography in the prediction of gout flares: a 12-month prospective observational study. In Rheumatology. Oxford University Press (OUP). https://doi.org/10.1093/rheumatology/keac367