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Introduction <p>Elevated serum urate (SU) may lead to monosodium urate (MSU) deposition in joints and tissues, resulting in gout flares and tophi. Deposited MSU imbalances osteoblast/osteoclast activity at the bone–tophus interface, resulting in bone erosions. Dual-energy computed tomography (DECT) can visualize MSU deposition and bone erosions in gout patients, but DECT is not widely available. Therefore, understanding gout-related bone/joint abnormalities with other imaging modalities is important.</p> Objective <p>This study aimed to characterize ultrasound changes associated with uncontrolled gout and determine whether therapeutic response to pegloticase urate-lowering therapy is reflected.</p> Methods <p>Patients with uncontrolled gout (pegloticase treatment initiated&#xa0;between 2018&#xa0;and 2022), who underwent joint ultrasound-imaging before therapy were included. De-identified medical record data through 1 May 2023 were collected, including patient/gout characteristics, available laboratory values, and ultrasound images/reports. Images were specifically examined for tophi, bone erosions, double-contour signs, and joint effusion/synovitis.</p> Results <p>Ten patients (70.0% male; age: 65.2 ± 15.3 years; body mass index [BMI]: 28.6 ± 4.9 kg/m<sup>2</sup>; gout duration: 7.8 ± 7.5 years; SU: 7.2 ± 2.6 mg/dL) were included. Before treatment, 9 (90%) had ≥ 1 imaging abnormality including tophi (90%), double-contour sign (70%), bone-erosion (60%), joint effusion (40%), and synovitis (40%). In patients with ≥ 1 abnormality, a median of three abnormality types (range 2–5) were identified. The one patient with no imaging abnormalities had prior amputation of the first metatarsophalangeal joint in the imaged foot. Two patients had matched imaging during/after pegloticase therapy; one showed double-contour sign resolution after 16 weeks of treatment (4 infusions; other ultrasound abnormalities persisted), and one showed marked tophus improvement at 26 weeks of treatment (11 infusions; total 18 pegloticase infusions over 40 weeks).</p> Conclusion <p>Ultrasound may be a useful imaging tool for diagnosing gout and monitoring treatment response to pegloticase urate-lowering therapy.</p>

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Ultrasound as a useful imaging modality to aid diagnosis and monitoring of pegloticase treatment response in patients with uncontrolled gout: a preliminary study

  • 期刊论文

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  • 发表日期：

    2025年6月27日

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  • Brigid Freyne,
  • Zana Vranic,
  • Lissa Padnick-Silver,
  • Ada Kumar,
  • Brian LaMoreaux

摘要

Introduction

Elevated serum urate (SU) may lead to monosodium urate (MSU) deposition in joints and tissues, resulting in gout flares and tophi. Deposited MSU imbalances osteoblast/osteoclast activity at the bone–tophus interface, resulting in bone erosions. Dual-energy computed tomography (DECT) can visualize MSU deposition and bone erosions in gout patients, but DECT is not widely available. Therefore, understanding gout-related bone/joint abnormalities with other imaging modalities is important.

Objective

This study aimed to characterize ultrasound changes associated with uncontrolled gout and determine whether therapeutic response to pegloticase urate-lowering therapy is reflected.

Methods

Patients with uncontrolled gout (pegloticase treatment initiated between 2018 and 2022), who underwent joint ultrasound-imaging before therapy were included. De-identified medical record data through 1 May 2023 were collected, including patient/gout characteristics, available laboratory values, and ultrasound images/reports. Images were specifically examined for tophi, bone erosions, double-contour signs, and joint effusion/synovitis.

Results

Ten patients (70.0% male; age: 65.2 ± 15.3 years; body mass index [BMI]: 28.6 ± 4.9 kg/m2; gout duration: 7.8 ± 7.5 years; SU: 7.2 ± 2.6 mg/dL) were included. Before treatment, 9 (90%) had ≥ 1 imaging abnormality including tophi (90%), double-contour sign (70%), bone-erosion (60%), joint effusion (40%), and synovitis (40%). In patients with ≥ 1 abnormality, a median of three abnormality types (range 2–5) were identified. The one patient with no imaging abnormalities had prior amputation of the first metatarsophalangeal joint in the imaged foot. Two patients had matched imaging during/after pegloticase therapy; one showed double-contour sign resolution after 16 weeks of treatment (4 infusions; other ultrasound abnormalities persisted), and one showed marked tophus improvement at 26 weeks of treatment (11 infusions; total 18 pegloticase infusions over 40 weeks).

Conclusion

Ultrasound may be a useful imaging tool for diagnosing gout and monitoring treatment response to pegloticase urate-lowering therapy.