Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Med Sci (Basel). 2024 Jul 31;12(3):37. doi: 10.3390/medsci12030037.
The accurate diagnosis of gout frequently constitutes a challenge in clinical practice, as it bears a close resemblance to other rheumatologic conditions. An undelayed diagnosis and an early therapeutic intervention using uric acid lowering therapy (ULT) is of the utmost importance for preventing bone destruction, the main point of managing gout patients. Advanced and less invasive imaging techniques are employed to diagnose the pathology and ultrasonography (US) stands out as a non-invasive, widely accessible and easily reproducible method with high patient acceptability, enabling the evaluation of the full clinical spectrum in gout. The 2023 EULAR recommendations for imaging in diagnosis and management of crystal-induced arthropathies in clinical practice state that US is a fundamental imagistic modality. The guidelines underline its effectiveness in detecting crystal deposition, particularly for identifying tophi and the double contour sign (DCS). Its utility also arises in the early stages, consequent to synovitis detection. US measures of monosodium urate (MSU) deposits are valuable indicators, sensitive to change consequent to even short-term administration of ULT treatment, and can be feasibly used both in current daily practice and clinical trials. This paper aimed to provide an overview of the main US features observed in gout patients with reference to standardized imaging guidelines, as well as the clinical applicability both for diagnosis accuracy and treatment follow-up. Our research focused on summarizing the current knowledge on the topic, highlighting key data that emphasize gout as one of the few rheumatological conditions where US is recognized as a fundamental diagnostic and monitoring tool, as reflected in the most recent classification criteria.
痛风的准确诊断在临床实践中常常构成挑战，因为它与其他风湿性疾病非常相似。及时诊断和早期使用尿酸降低疗法（ULT）进行治疗对于预防骨破坏至关重要，这是管理痛风患者的要点。先进的、侵入性较小的成像技术用于诊断病理学，超声检查（US）作为一种非侵入性、广泛可及且易于重复的方法，具有较高的患者接受度，能够评估痛风的全部临床表现，因此脱颖而出。2023 年 EULAR 关于晶体性关节病诊断和管理中成像的建议指出，US 是一种基本的成像方式。该指南强调了其在检测晶体沉积方面的有效性，特别是对于识别痛风石和双轮廓征（DCS）。它在早期也具有实用性，能够检测到滑膜炎。尿酸单钠（MSU）沉积的 US 测量值是有价值的指标，对 ULT 治疗短期治疗后的变化敏感，并且可以在当前的日常实践和临床试验中合理使用。本文旨在根据标准化成像指南，概述痛风患者的主要 US 特征，并讨论其在诊断准确性和治疗随访方面的临床适用性。我们的研究重点总结了该主题的最新知识，强调了关键数据，这些数据强调了痛风是少数几种被认为 US 是基本诊断和监测工具的风湿性疾病之一，这反映在最新的分类标准中。
