ASSESSMENT OF CLINICAL AND ULTRASONOGRAPHIC CHANGES IN PATIENTS WITH GOUT AFTER ONE YEAR OF TREATMENT

Background: Imaging may be useful for monitoring the response to therapy. Within the OMERACT proposal for the core set domains for outcome measures in chronic gout, serum urate levels, recurrence of gouty flares, tophus regression, and joint damage imaging have been included, among other proposed issues. Objectives: To evaluate the sensitivity to change of ultrasound after one year of treatment in gouty patients and its relation with clinical and analytical outcomes. Methods: We evaluate in a prospective study patients with diagnosis of gout clinically active. One rheumatologist (AV) performs a clinical assessment, determining number of tender joints (TJC), swelling joints (SJC) and the patient global assessment of the disease (PGA) by visual analogical scale, in mm. Blood test to assess, among other parameters, uricemia and acute phase reactants (ESR and CRP), were determined. Patients were assessed every three months, adjusting treatment in each visit by usual clinical practice. A second rheumatologist (DP), blind to clinical data, performs the ultrasonography exploration, basal and at one year, using a Logiq 9 equipment (General Electric, Wauwatosa WI, USA) with a 9-14 Mhz probe for grey-scale and Doppler colour. The following anatomic areas are bilaterally explored: a) Joints: first metatarsophalangeal (1MTP), tarsus, ankle recesses, knee recesses and cartilage and b) Tendons: tibialis anterior, peroneals and patellar. The total number of anatomic areas explored in each patient were 24. In each area were assessed the presence of Doppler signal (Dp) and, in 1MTP and knee, the double contour sign in cartilage (DC). Results: We evaluate the data of 17 patients (1 female, 16 males), with a median age of 60±8.6 years. The means of the basal data are showed in Table 1. After one year, the uricemia had a mean reduction of 2.6±2.02 mg/dL (p<0.01). Also, significantly reductions were observed in TJC (p=0.027) and PGA (p=0.044). The ultrasound DC sign achieved significant reduction in patients who reached the aim of uricemia <6 mg/dL (8 patients); however, patients in whom levels did not dropped below 6mg/dl DC did not change (9 patients) (Table 2). Others objective parameters of activity as Dp, SJC, ESR and CRP, showed reduction but not significantly. Table 1. Means (±DS) of clinic and ultrasonographic outcomes in basal and 12 months visits UricemiaTJCSJCESRCRPPGADpDC Basal8.47±2.153.06±7.891.53±3.819.55±8.586.31±7.5419.5±12.58.23±3.030.941±1.14 12 m.5.86±0.661.94±6.730.71±1.965.64±4.522.06±2.0813.25±11.76.352±4.010.470±0.80 p0.001*0.027*0.0950.1450.1160.044*0.1090.072 Table 2. Means (±DS) of ultrasonographic outcomes at basal and 12 months visits, according uricemia level reached at year of monitoring DpDC Uric <6 mg/dL Basal8.25±3.151.25±1.39 Uric <6 mg/dL 12 m.6.00±2.670.25±0.46 p0.0570.05* Uric ≥6 mg/dL Basal8.22±3.110.67±0.87 Uric ≥6 mg/dL 12 m.6.67±5.070.67±1.0 p0.9471.0 Conclusion: Treatment of gout after one year of treatment showed a significant improvement in subjective parameters. However inflammatory objective activity outcomes such as, SJC, ESR, CRP and presence of Doppler signal improved but without statistical significance Double contour sign shows sensitivity to change and construct validity with reduction of hyperuricemia. Both ultrasound signs double contour and Doppler reinforce the opportunity of ultrasound becoming an outcome in monitoring gout treatment response. Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 715Session: Diagnostics and imaging procedures (Abstracts accepted for publication )