Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved
This study aimed at determining whether lowering serum urate (SU) to less than 6 mg/dl in patients with gout affects ultrasonographic findings. Seven joints in five patients with monosodium urate (MSU) crystal proven gout and hyperuricemia were examined over time with serial ultrasonography. Four of...
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| Veröffentlicht in: | Rheumatology international 2010-02, Vol.30 (4), p.495-503 |
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| description | This study aimed at determining whether lowering serum urate (SU) to less than 6 mg/dl in patients with gout affects ultrasonographic findings. Seven joints in five patients with monosodium urate (MSU) crystal proven gout and hyperuricemia were examined over time with serial ultrasonography. Four of the five patients were treated with urate lowering drugs (ULDs) (allopurinol,
n
= 3; probenecid,
n
= 1). One patient was treated with colchicine alone. Attention was given to changes in a hyperechoic, irregular coating of the hyaline cartilage in the examined joints (double contour sign or “urate icing”). 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 follow-up images ranged from 7 to 18 months. Serial SU levels were obtained during the follow-up period. During the follow-up period, three patients treated with ULD (allopurinol,
n
= 2; probenecid,
n
= 1) achieved a SU level of |
| doi_str_mv | 10.1007/s00296-009-1002-8 |
| format | Article |
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n
= 3; probenecid,
n
= 1). One patient was treated with colchicine alone. Attention was given to changes in a hyperechoic, irregular coating of the hyaline cartilage in the examined joints (double contour sign or “urate icing”). 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 follow-up images ranged from 7 to 18 months. Serial SU levels were obtained during the follow-up period. During the follow-up period, three patients treated with ULD (allopurinol,
n
= 2; probenecid,
n
= 1) achieved a SU level of <6 mg/dl. In two patients, SU levels remained above 6 mg/dl (treated with allopurinol,
n
= 1; treated with colchicine,
n
= 1). At baseline, the double contour sign was seen in all patients. In those patients who achieved SU levels of <6 ml/dl, this sign had disappeared at follow-up. Disappearance of the double contour sign was seen in two knee joints, two first MTP joints, and one MCP joint. In contrast, disappearance of the double contour sign was not seen in patients who maintained a SU level ≥7 mg/dl. In one patient treated with allopurinol, SU levels improved from 13 to 7 mg/dl during the follow-up period. Decrease, but not resolution of the hyperechoic coating was seen in this patient. In the patient treated with colchicine alone, SU levels remained >8 mg/dl, and no sonographic change was observed. In our patients, sonographic signs of deposition of MSU crystals on the surface of hyaline cartilage disappeared completely if sustained normouricemia was achieved. This is the first report showing that characteristic sonographic changes are influenced by ULDs once SU levels remain ≤6 mg/dl for 7 months or more. Sonographic changes of gout correlate with SU levels and may be a non-invasive means to track changes in the uric acid pool. Larger prospective studies are needed to further assess these potentially important findings.</description><identifier>ISSN: 0172-8172</identifier><identifier>EISSN: 1437-160X</identifier><identifier>DOI: 10.1007/s00296-009-1002-8</identifier><identifier>PMID: 19543895</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Aged ; Aged, 80 and over ; Allopurinol - therapeutic use ; Cartilage ; Cartilage, Articular - drug effects ; Cartilage, Articular - metabolism ; Cartilage, Articular - pathology ; Colchicine - therapeutic use ; Crystallization ; Female ; Gout - blood ; Gout - drug therapy ; Gout - pathology ; Gout Suppressants - therapeutic use ; Humans ; Hyaline Cartilage - drug effects ; Hyaline Cartilage - metabolism ; Hyaline Cartilage - pathology ; Joints - diagnostic imaging ; Joints - pathology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Probenecid - therapeutic use ; Rheumatology ; Treatment Outcome ; Ultrasonography ; Uric Acid - metabolism</subject><ispartof>Rheumatology international, 2010-02, Vol.30 (4), p.495-503</ispartof><rights>Springer-Verlag 2009</rights><rights>Springer-Verlag 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-abf78a696781cfbfcfac2d7d7ecbf9930df99610c7cd599d70d22f4b6e595c303</citedby><cites>FETCH-LOGICAL-c495t-abf78a696781cfbfcfac2d7d7ecbf9930df99610c7cd599d70d22f4b6e595c303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00296-009-1002-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00296-009-1002-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19543895$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thiele, Ralf G.</creatorcontrib><creatorcontrib>Schlesinger, Naomi</creatorcontrib><title>Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved</title><title>Rheumatology international</title><addtitle>Rheumatol Int</addtitle><addtitle>Rheumatol Int</addtitle><description>This study aimed at determining whether lowering serum urate (SU) to less than 6 mg/dl in patients with gout affects ultrasonographic findings. Seven joints in five patients with monosodium urate (MSU) crystal proven gout and hyperuricemia were examined over time with serial ultrasonography. Four of the five patients were treated with urate lowering drugs (ULDs) (allopurinol,
n
= 3; probenecid,
n
= 1). One patient was treated with colchicine alone. Attention was given to changes in a hyperechoic, irregular coating of the hyaline cartilage in the examined joints (double contour sign or “urate icing”). 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 follow-up images ranged from 7 to 18 months. Serial SU levels were obtained during the follow-up period. During the follow-up period, three patients treated with ULD (allopurinol,
n
= 2; probenecid,
n
= 1) achieved a SU level of <6 mg/dl. In two patients, SU levels remained above 6 mg/dl (treated with allopurinol,
n
= 1; treated with colchicine,
n
= 1). At baseline, the double contour sign was seen in all patients. In those patients who achieved SU levels of <6 ml/dl, this sign had disappeared at follow-up. Disappearance of the double contour sign was seen in two knee joints, two first MTP joints, and one MCP joint. In contrast, disappearance of the double contour sign was not seen in patients who maintained a SU level ≥7 mg/dl. In one patient treated with allopurinol, SU levels improved from 13 to 7 mg/dl during the follow-up period. Decrease, but not resolution of the hyperechoic coating was seen in this patient. In the patient treated with colchicine alone, SU levels remained >8 mg/dl, and no sonographic change was observed. In our patients, sonographic signs of deposition of MSU crystals on the surface of hyaline cartilage disappeared completely if sustained normouricemia was achieved. This is the first report showing that characteristic sonographic changes are influenced by ULDs once SU levels remain ≤6 mg/dl for 7 months or more. Sonographic changes of gout correlate with SU levels and may be a non-invasive means to track changes in the uric acid pool. Larger prospective studies are needed to further assess these potentially important findings.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Allopurinol - therapeutic use</subject><subject>Cartilage</subject><subject>Cartilage, Articular - drug effects</subject><subject>Cartilage, Articular - metabolism</subject><subject>Cartilage, Articular - pathology</subject><subject>Colchicine - therapeutic use</subject><subject>Crystallization</subject><subject>Female</subject><subject>Gout - blood</subject><subject>Gout - drug therapy</subject><subject>Gout - pathology</subject><subject>Gout Suppressants - therapeutic use</subject><subject>Humans</subject><subject>Hyaline Cartilage - drug effects</subject><subject>Hyaline Cartilage - metabolism</subject><subject>Hyaline Cartilage - pathology</subject><subject>Joints - diagnostic imaging</subject><subject>Joints - pathology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Probenecid - therapeutic use</subject><subject>Rheumatology</subject><subject>Treatment Outcome</subject><subject>Ultrasonography</subject><subject>Uric Acid - metabolism</subject><issn>0172-8172</issn><issn>1437-160X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kd-K1TAQxoMo7tnVB_BGglfeVJO0TZpLWVZdWPDGBe_KNH_OydI2NdMq5xF8a2c5BxYEIUz4Mr_5MvAx9kaKD1II8xGFUFZXQtiKtKq6Z2wnm9pUUosfz9lOSEOPVC7YJeKDIK21eMkupG2burPtjv25H9cCmOe8L7AcjhwP-TdynxCWJUCB2QWeI5-IwOzTNvGtwBq4K0dcYeQ-LBnTmvLM6RyOMKaZulDWNMI-cIhrKBw3gqnh-ZzLlLeSXJgS8IQc3CGFX8G_Yi8ijBhen-8rdv_55vv11-ru25fb6093lWtsu1YwRNOBttp00sUhughOeeNNcEO0thaeqpbCGedba70RXqnYDDq0tnW1qK_Y-5PvUvLPLeDaTwldGEeYQ96wl41VWqraGkLf_YM-0Oozbdd3Rta1sEIRJE-QKxmxhNgvJU1Qjr0U_WNM_SmmnmJ61KrvaObt2XgbpuCfJs65EKBOAFJr3ofy9PP_Xf8CuIih5w</recordid><startdate>20100201</startdate><enddate>20100201</enddate><creator>Thiele, Ralf G.</creator><creator>Schlesinger, Naomi</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7QP</scope></search><sort><creationdate>20100201</creationdate><title>Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved</title><author>Thiele, Ralf G. ; Schlesinger, Naomi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-abf78a696781cfbfcfac2d7d7ecbf9930df99610c7cd599d70d22f4b6e595c303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Allopurinol - therapeutic use</topic><topic>Cartilage</topic><topic>Cartilage, Articular - drug effects</topic><topic>Cartilage, Articular - metabolism</topic><topic>Cartilage, Articular - pathology</topic><topic>Colchicine - therapeutic use</topic><topic>Crystallization</topic><topic>Female</topic><topic>Gout - blood</topic><topic>Gout - drug therapy</topic><topic>Gout - pathology</topic><topic>Gout Suppressants - therapeutic use</topic><topic>Humans</topic><topic>Hyaline Cartilage - drug effects</topic><topic>Hyaline Cartilage - metabolism</topic><topic>Hyaline Cartilage - pathology</topic><topic>Joints - diagnostic imaging</topic><topic>Joints - pathology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Probenecid - therapeutic use</topic><topic>Rheumatology</topic><topic>Treatment Outcome</topic><topic>Ultrasonography</topic><topic>Uric Acid - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thiele, Ralf G.</creatorcontrib><creatorcontrib>Schlesinger, Naomi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Calcium & Calcified Tissue Abstracts</collection><jtitle>Rheumatology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thiele, Ralf G.</au><au>Schlesinger, Naomi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved</atitle><jtitle>Rheumatology international</jtitle><stitle>Rheumatol Int</stitle><addtitle>Rheumatol Int</addtitle><date>2010-02-01</date><risdate>2010</risdate><volume>30</volume><issue>4</issue><spage>495</spage><epage>503</epage><pages>495-503</pages><issn>0172-8172</issn><eissn>1437-160X</eissn><abstract>This study aimed at determining whether lowering serum urate (SU) to less than 6 mg/dl in patients with gout affects ultrasonographic findings. Seven joints in five patients with monosodium urate (MSU) crystal proven gout and hyperuricemia were examined over time with serial ultrasonography. Four of the five patients were treated with urate lowering drugs (ULDs) (allopurinol,
n
= 3; probenecid,
n
= 1). One patient was treated with colchicine alone. Attention was given to changes in a hyperechoic, irregular coating of the hyaline cartilage in the examined joints (double contour sign or “urate icing”). 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 follow-up images ranged from 7 to 18 months. Serial SU levels were obtained during the follow-up period. During the follow-up period, three patients treated with ULD (allopurinol,
n
= 2; probenecid,
n
= 1) achieved a SU level of <6 mg/dl. In two patients, SU levels remained above 6 mg/dl (treated with allopurinol,
n
= 1; treated with colchicine,
n
= 1). At baseline, the double contour sign was seen in all patients. In those patients who achieved SU levels of <6 ml/dl, this sign had disappeared at follow-up. Disappearance of the double contour sign was seen in two knee joints, two first MTP joints, and one MCP joint. In contrast, disappearance of the double contour sign was not seen in patients who maintained a SU level ≥7 mg/dl. In one patient treated with allopurinol, SU levels improved from 13 to 7 mg/dl during the follow-up period. Decrease, but not resolution of the hyperechoic coating was seen in this patient. In the patient treated with colchicine alone, SU levels remained >8 mg/dl, and no sonographic change was observed. In our patients, sonographic signs of deposition of MSU crystals on the surface of hyaline cartilage disappeared completely if sustained normouricemia was achieved. This is the first report showing that characteristic sonographic changes are influenced by ULDs once SU levels remain ≤6 mg/dl for 7 months or more. Sonographic changes of gout correlate with SU levels and may be a non-invasive means to track changes in the uric acid pool. Larger prospective studies are needed to further assess these potentially important findings.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>19543895</pmid><doi>10.1007/s00296-009-1002-8</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Rheumatology international, 2010-02, Vol.30 (4), p.495-503 |
| issn | 0172-8172 1437-160X |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Aged Aged, 80 and over Allopurinol - therapeutic use Cartilage Cartilage, Articular - drug effects Cartilage, Articular - metabolism Cartilage, Articular - pathology Colchicine - therapeutic use Crystallization Female Gout - blood Gout - drug therapy Gout - pathology Gout Suppressants - therapeutic use Humans Hyaline Cartilage - drug effects Hyaline Cartilage - metabolism Hyaline Cartilage - pathology Joints - diagnostic imaging Joints - pathology Male Medicine Medicine & Public Health Middle Aged Original Article Probenecid - therapeutic use Rheumatology Treatment Outcome Ultrasonography Uric Acid - metabolism |
| title | Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved |
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