Abstract
Ultrasound is indispensable when evaluating gout or calcium pyrophosphate deposition disease. For gout, distinct sonographic findings are detectable, including the double contour sign and recognition of a gouty tophus. Although finding uric acid crystals in synovial fluid is still the gold standard for diagnosing gout, patients are classified as having gout if specific criteria are met, even without a joint aspiration. One of those criteria, the double contour sign, is a layering of monosodium urate crystals on cartilage surfaces and has been found sufficiently helpful to be incorporated into the 2015 American College of Rheumatology/European League Against Rheumatism classification criteria for gout. This sonographic sign is particularly useful when joint aspiration is challenging or declined by the patient. Diagnosis is the first step to treatment. For calcium pyrophosphate deposition disease, aspiration with crystal examination is the benchmark for diagnosis, but sometimes it is not feasible. In the correct clinical setting, calcium crystals in classic areas such as the wrist and the distal femoral cartilage strongly argue for calcium pyrophosphate deposition disease as a diagnosis. Crystalline arthritis can mimic inflammatory arthritis, and the sonographic discovery of evidence for crystal disease opens up this possibility even in patients lacking clinical and laboratory findings. The aspiration of a small effusion is also facilitated by ultrasound.
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Greenberg, M.H., Day, A.L., Alradawi, S. (2023). Crystalline Disease. In: Manual of Musculoskeletal Ultrasound . Springer, Cham. https://doi.org/10.1007/978-3-031-37416-6_24
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DOI: https://doi.org/10.1007/978-3-031-37416-6_24
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