Criteria of Loeffler et al for Distinguishing Gouty Arthritis from Other Arthritides on Ultrasonography

Description

Loeffler et al used ultrasonography and laboratory testing to evaluate patients with arthritis. Certain findings can help to identify patients likely to have a crystal-based arthropathy. The authors are from Klinikum Ludwigshafen, University Hospital Mannheim and University of Heidelberg in Germany.

Patient selection: arthritis

Diagnostic groups:

(1) crystal related arthritis (CRA): gout and pseudogout (calcium pyrophosphate disease, CPPD)

(2) not crystal related: inflammatory and non-inflammatory

Parameters:

(1) double contour (DC) sign on ultrasonography

(2) vascularization on ultrasonography

(3) serum uric acid in mg/dL

With crystal-related arthritis there is hyperechoic enhancement of the articular cartilage. The double contour (DC) sign is a thickening of the superficial synovial margin.

Vascular Appearance	Grade
none	0
1 to 3 distinct Doppler signals	1
4 or more distinct Doppler signals	2
large, converging Doppler signal	3

Double Contour Sign	Vascularity and Uric Acid	Diagnosis
negative	NA	more likely not crystal related (but could be either CRA)
positive	vascularity 2 or 3, serum uric acid > 7.5 mg/dL	more likely to be gout but can be seen with CPPD and inflammatory arthritis
positive	other	more likely to be gout or CPPD but can be seen with inflammatory arthritis

where:

• The DC sign was not seen with non-inflammatory arthritis.

• The upper limit of the normal reference range for uric acid was 7.5 mg/dL.

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Criteria of Loeffler et al for Distinguishing Gouty Arthritis from Other Arthritides on Ultrasonography

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