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Clin Exp Rheumatol. 2012 Jul-Aug;30(4):499-504. Epub 2012 Aug 29.

Ultrasonography in gout: a case-control study.

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Université Paris Diderot, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France.



To determine the sensitivity and specificity of ultrasonography for gout, and to investigate the relationship with severity of gout.


In this case-control study, we prospectively enrolled 53 patients with crystal-proven gout and 50 controls. Ultrasonography was performed on 10 joints for each patient (metatarsophalangeal [MTP] joints 1-2, knees, metacarpophalangeal [MCP] joints 2-3) to determine the prevalence of the double contour (DC) sign and tophi in each site.


We assessed 530 joints in gouty patients and 500 in controls. Gouty patients had a mean disease duration 9.2±10.7 years and a mean of 14.7±19.8 acute attacks. Clinical exam revealed tophi in 44% of patients. Mean urate level was 656.7±145.3 μM. Inter-reader agreement between the 2 sonographers was excellent for both DC sign and tophi. The frequency of the DC sign in MTPs, knees and MCPs for gouty patients and controls was 67% vs. 2%, 57% vs. 0%, and 21% vs. 0%, respectively (all p<0.001), whereas that of tophi, only found in gouty patients, was 74%, 42% and 22%, respectively (p<0.001). The sensitivity of the DC sign was 67% for MTPs, 57% for knees and 21% for MCPs, and specificity was high (all >98%). The sensitivity of tophi was 74%, 42% and 22%, respectively, and specificity 100% for all sites. For MTPs, the DC sign, but not tophi, was significantly associated with uricemia (p<0.05) and disease duration (p=0.01).


Ultrasonography has good sensitivity and specificity to diagnose gout. Sensitivity depends on disease duration, joint site and severity of the disease.

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