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Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved
Rheumatology International, 06/25/09

Thiele RG et al. – Study reports that characteristic sonographic changes are influenced by urate lowering drugs (ULDs) once serum urate (SU) levels remain ≤6 mg/dl for ≥7 months. Sonographic changes of gout correlate with SU levels and may be a non-invasive means to track changes in the uric acid pool.

• Aim was to determine whether lowering SU to <6 mg/dl in pts with gout affects ultrasonographic findings
• 7 joints in 5 pts with proven gout and hyperuricemia were examined over time with serial ultrasonography
• 4/5 pts were treated with ULDs: allopurinol, n=3; probenecid, n=1
• 1 patient was treated with colchicine alone
• Attention was given to changes in a hyperechoic, irregular coating of the hyaline cartilage
• This coating was considered to represent precipitate of MSU crystals
• Index joints included metacarpophalangeal (MCP) joints (n=2), knee joints (n=3), and first metatarsophalangeal (MTP) joints (n=2)
• The interval between baseline and f/u images ranged from 7-18 mo
• Serial SU levels were obtained during the f/u period

• During the f/u period, 3 pts treated with ULD achieved a SU level of <6 mg/dl
• In 2 pts, SU levels remained above 6 mg/dl
• At baseline, the double contour sign was seen in all pts
• In those pts who achieved SU levels of <6 ml/dl, this sign had disappeared at f/u
• Disappearance of the double contour sign was seen in 2 knee joints, 2 first MTP joints, and 1 MCP joint
• In contrast, disappearance of the double contour sign was not seen in pts who maintained a SU level ≥7 mg/dl
• In 1 patient treated with allopurinol, SU levels improved from 13 to 7 mg/dl during the f/u period
• Decrease, but not resolution of the hyperechoic coating was seen in this patient
• In patient treated with colchicine alone, SU levels remained >8 mg/dl, and no sonographic change was observed
• Sonographic signs of deposition of MSU crystals on the surface of hyaline cartilage disappeared completely if sustained normouricemia was achieved

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