Double Contour Sign In Early Detection Of Gout Among Asymptomatic Hyperuricemic Filipino Patients: A Single Center Tertiary Hospital Observational Study
Julie Li-Yu, Dominic Dela Cruz, Millicent Tan-Ong, Leonid Zamora, Richelle Joy Bayson
Dec 2022 DOI 10.35460/2546-1621.2022-sp11 Access
Objective. Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients.
Methods. Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign.
Results. Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p<0.001).
Conclusion and Recommendation. There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis maybe necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.
- Thiele RG, Schlesinger N: Diagnosis of gout by ultrasound. Rheumatology (Oxford) 2007;46(7):1116-21
- Bhadu D, Das SK, Wakhlu A, Dhakad U. Articular cartilage of knee and first MTP joint are the preferred sites to find double contour sign as an evidence of urate crystal deposition in asymptomatic hyperuricemic individuals. Acta Reumatol Port. 2018;43(4):264-8
- Thiele RG, Schlesinger N: Ultrasonography shows disappearance of monosodium urate crystal deposition on hya line cartilage after sustained normouricemia is achieved. Rheumatol Int 2010;30(4):495-503.
- Neogi T, Jansen L, Th A, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria. An American College of Rheumatology /European League Against Rheumatism collaborative initiative. Arthritis and Rheumatology 2015;67(10):2557–68
- Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez Henriquez P, Hernandez-Diaz C, Vargas A, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res 2011;13(1):R4
- Stewart S, Dalbeth N, Vandal AC, Allen B, Miranda R, Rome K. Ultrasound features of the first metatarsophalangeal joint in gout and asymptomatic hyperuricemia: comparison with normouricemic individuals. Arthritis Care & Research 2017:69(6);875-83
- Ottaviani S, Gill G, Aubrun A, Palazzo E, Meyer O, Dieudé P. Ultrasound in gout: a useful tool for following urate-lowering therapy. Joint Bone Spine 2015;82(1):42–4
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