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Imaging
Original research
Assessing the sensitivity to change of the OMERACT ultrasound structural gout lesions during urate-lowering therapy
  1. Sara Nysom Christiansen1,2,
  2. Mikkel Østergaard1,2,
  3. Ole Slot1,
  4. Helen Keen3,
  5. George A W Bruyn4,
  6. Maria Antonietta D'Agostino5 and
  7. Lene Terslev1,2
  1. 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
  2. 2Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  3. 3School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
  4. 4Department of Rheumatology, MC Hospital Group, Lelystad, The Netherlands
  5. 5Rheumatology, Ambroise Paré Hospital, APHP, Université Versailles-Saint-Quentin en Yvelines, Boulogne-Billancourt, France
  1. Correspondence to Dr Sara Nysom Christiansen; sara.nysom.christiansen{at}regionh.dk

Abstract

Objectives To evaluate the sensitivity to change of ultrasound structural gout lesions, as defined by the Outcome Measures in Rheumatology (OMERACT) ultrasound group, in patients with gout during urate-lowering therapy (ULT).

Methods Ultrasound (28 joints, 26 tendons) was performed in patients with microscopically verified gout initiating or increasing ULT and repeated after 3 and 6 months. Joints and tendons were evaluated by ultrasound for presence of the OMERACT structural gout lesions—double contour sign (DC), tophus, aggregates and erosion—scored binarily. A sum score was calculated at patient and lesion level. Changes at 3 and 6 months in patient sum scores and lesion scores at different locations were evaluated.

Results 50 patients (48 men), mean age 68.9 (range, 30–88) years, were included. Ultrasound showed a statistically significant decrease in DC and tophus sum scores from 0 months (3.16 and 2.68, respectively) to 3 months (2.33 and 2.43) and 6 months (1.34 and 1.83) (all p<0.002). The aggregate sum score only decreased significantly from 3 to 6 months (6.02 to 5.02, p=0.002), whereas erosion sum score remained almost unchanged. All four structural lesions were most commonly found in metatarsophalangeal (MTP) 1 joints (>1 lesions bilaterally), and furthermore MTP2–4 and knee joints were common sites especially for DC. Likewise, these regions were the locations with most pronounced changes in scores.

Conclusion Ultrasound assessment of the OMERACT structural gout lesions scored binarily seems to be a useful tool for monitoring urate depositions during ULT. Particularly DC and tophus showed sensitivity to change after only 3 months of treatment.

  • ultrasound
  • gout
  • OMERACT
  • double contour sign
  • tophus
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2019-001144

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    Footnotes

    • Contributors SNC has made substantial contributions to study conception and design, acquisition of data, analysis and interpretation of data, drafting the article and final approval of the version of the article to be published. MØ has made a substantial contribution to study conception and design, analysis and interpretation of data, revising the article critically for important intellectual content and final approval of the version of the article to be published. OS and LT have made a substantial contribution to study conception and design, acquisition of data, analysis and interpretation of data, revising the article critically for important intellectual content and final approval of the version of the article to be published. HK, GB and MAD have made a substantial contribution to analysis and interpretation of data, revising the article critically for important intellectual content and final approval of the version of the article to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SNC has received speaker fees from Bristol Myers Squibb (BMS) and General Electric (GE). LT has received speakers’ fees from AbbVie, MSD, Novartis, Roche, Pfizer, General Electric (GE), Bristol Myers Squibb (BMS) and Janssen. MØ has received research support and/or consultancy/speaker fees from Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth.

    • Patient consent for publication Obtained.

    • Ethics approval The study was approved by the Danish ethical committee (H-16043367).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.