cartouche ECN WORKSHOP

Ultrasound evaluation in follow-up of urate-lowering therapy in gout : the useful study


Esther Ebstein (1), Marine Forien (1), Eleonora Norkuviene (2), Pascal Richette (3), Gaël Mouterde (4), Claire Daien (4), Hang-Korng Ea (3), Claire Brière (3), Frédéric Lioté (3), Mykolas Petraitis (2), Thomas Bardin (3), Jérémy Ora (3), Philippe Dieudé(1), Sébastien Ottaviani (1)



1. Rheumatology Department, DHU Fire, Pôle Infection Immunité, Bichat Hospital (Aphp), Paris, France
2. Rheumatology Department, Lithuanian University Of Health Sciences, Kaunas, Lithuania
3.Rheumatology Department, Centre Viggo Petersen, Pôle Appareil Locomoteur, Lariboisière Hospital (AP-HP); Inserm UMR 1132, USPC, Paris, France
4. Rheumatology Department, Lapeyronie Hospital, Aa 2415, Montpellier University Montpellier, France



Patients and Methods : We performed a 6-month multicentre prospective study including patients with 1) proven gout, 2) presence of US features of gout (tophus and/or double contour [DC] sign) at the knee and/or first metatarsophalangeal joints, and 3) no current ULT. US evaluations were performed at baseline and at months 3 and 6 (M3, M6) after starting ULT. Outcomes were 1) the change in US features of gout at M6 according to final (M6) serum uric acid (SUA) level (high, > 360 µmol/l; low, 300–360 µmol/l; very low, < 300 µmol/l), and 2) correlation between changed US features and final SUA level.

Results : We included 79 gouty patients (mean ± SD, age 61.8 ±14 years, 91% males, disease duration 6.3 ± 6.1 years). Baseline SUA level was 530 ± 97 µmol/l. At least one US tophus and DC sign was observed in 74 (94%) and 68 (86%) patients, respectively. Among the 67 completers at M6, 18 and 39 achieved a very low and low SUA level, respectively. We found a significant decrease in US features of gout among patients with the lowest SUA level (p <0.001). Final M6 SUA level was positively correlated with decreased size of tophus (r=0.54 [95% confidence interval: 0.34; 0.70], p <0.0001), and inversely correlated with proportion of DC sign disappearance
(r=-0.59 [-0.74; -0.40]).

Conclusions : US can show decreased urate deposition after ULT, which is correlated with decreased SUA level. The responsiveness of US in gout is demonstrated and can be useful for gout follow-up and adherence to ULT.