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Ultrasound in Crystalline Diseases: Gout and Calcium-Associated Arthritis

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Musculoskeletal Ultrasound in Rheumatology Review

Abstract

Crystal-associated arthropathies are common. Basic calcium phosphate can be associated with osteoarthritis. Calcium pyrophosphate dihydrate (CPPD) can be associated with chronic low-grade inflammation and with episodes of pseudogout. Tophi and smaller aggregates of monosodium urate (MSU) can lead to erosive, deforming arthropathy and recurrent attacks of gout. Incidence and prevalence of gout are increasing. Aspiration and polarizing microscopy, the gold standard, are not always performed. Ultrasound detects crystal deposition readily and can improve diagnosis and management. BCP crystals appear sonographically as small spheres that can aggregate to form a collection of such “bubbles.” They are found in basal joints of the thumb, finger joints, and joints of the midfoot. CPPD crystals are generated within hyaline cartilage and fibrocartilage and are found predominantly there, typically forming a hyperechoic layer in the center of cartilage. MSU crystals form tophi embedded in vascularized granulation tissue, deposit over hyaline cartilage, and create a sonographic double contour sign or form small hyperechoic aggregates within tissues. The inflammatory changes associated with crystal arthritis can be documented with color or power Doppler ultrasound. In contrast to other imaging modalities, ultrasound can be performed safely and relative inexpensively over time, is sensitive to change, and can therefore assess the treatment response.

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Authors and Affiliations

  1. Division of Allergy/Immunology & Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Ralf G. Thiele

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Correspondence to Ralf G. Thiele .

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  1. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Minna J. Kohler

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Thiele, R.G. (2021). Ultrasound in Crystalline Diseases: Gout and Calcium-Associated Arthritis. In: Kohler, M.J. (eds) Musculoskeletal Ultrasound in Rheumatology Review. Springer, Cham. https://doi.org/10.1007/978-3-030-73555-5_13

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  • DOI: https://doi.org/10.1007/978-3-030-73555-5_13

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