In patients with acute mono/oligoarthritis, a targeted ultrasound scanning protocol shows great accuracy for the diagnosis of gout and CPPD
In patients with acute mono/oligoarthritis, a targeted ultrasound scanning protocol shows great accuracy for the diagnosis of gout and CPPD
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DOI：
10.1093/rheumatology/keac479
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发表时间：
2022-08-23
期刊：
影响因子：
5.5
通讯作者：
Di Matteo, Andrea
中科院分区：
文献类型：
--
作者：
Cipolletta, Edoardo;Filippucci, Emilio;Di Matteo, Andrea
目标。目的：确定一种准确诊断不明原因急性单/少关节炎患者痛风和CPPD的超声扫描方案。急性单/少关节炎患者被要求在临床最累及的关节（目标关节）进行关节抽吸。每位患者在关节穿刺前进行US检查。计算了不同超声检查结果和扫描方案对痛风和CPPD诊断的准确性。共纳入161例受试者，其中痛风患者32例，CPPD患者30例，疾病对照99例。US检查结果对痛风（0.92-0.96）和CPPD（0.90-0.97）有很高的特异性，而痛风（双轮廓征和痛风）的敏感性为0.73 - 0.85，CPPD（透明质和纤维软骨沉积）的敏感性为0.60 - 0.90。US评估双侧两个关节（痛风：膝关节，MTP1关节；CPPD：膝关节，手腕）加上目标关节具有良好的诊断敏感性（痛风：0.91,CPPD: 0.93）和特异性（痛风：0.91,CPPD: 0.89）。与US评估的目标关节曲线下痛风面积（AUC）相比，该靶向US扫描方案的诊断准确性更高[0.91 vs 0.84, P = 0.03]；CPPD的AUC为0.93 vs 0.84, P = 0.04]，除非痛风患者的目标关节为膝关节或MTP1关节，CPPD患者的目标关节为膝关节或腕关节。双侧两个关节加靶关节的靶向US扫描方案在诊断急性单/少关节炎患者的晶体关节炎方面显示出极好的准确性（>90%）。
Objectives. To determine an US scanning protocol with the best accuracy for the diagnosis of gout and CPPD in patients with acute mono/oligo-arthritis of unknown origin.Methods. Patients with acute mono/oligo-arthritis in whom a joint aspiration at the most clinically involved joint (target joint) was requested were consecutively enrolled. US was performed in each patient before the arthrocentesis. The accuracy of different US findings and scanning protocols for the diagnosis of gout and CPPD was calculated.Results. A total of 161 subjects were included (32 gout patients, 30 CPPD patients and 99 disease-controls). US findings had a high specificity for gout (0.92-0.96) and CPPD (0.90-0.97), while the sensitivity ranged from 0.73 to 0.85 in gout (double contour sign and tophi, respectively) and from 0.60 to 0.90 in CPPD (hyaline and fibrocartilage deposits, respectively). The US assessment of two joints bilaterally (gout: knees, MTP1 joints; CPPD: knees, wrists) plus the target joint had an excellent diagnostic sensitivity (gout: 0.91, CPPD: 0.93) and specificity (gout: 0.91, CPPD: 0.89). This targeted US scanning protocol yielded to higher diagnostic accuracy compared with the US evaluation of the target joint [gout area under the curve (AUC) 0.91 vs 0.84, P = 0.03; CPPD AUC 0.93 vs 0.84, P = 0.04] unless the target joint was the knee or the MTP1 joint in gout and the knee or the wrist in CPPD.Conclusions. A targeted US scanning protocol of two joints bilaterally plus the target joint showed an excellent accuracy (>90%) for the diagnosis of crystal arthritis in patients with acute mono/oligoarthritis.