Make the pain visible! Musculoskeletal ultrasound makes the diagnosis of gout patients more "visualized"

"Doctor, please help me to ultrasound my knee joint. It hurts so much after I had a seafood dinner last night." Recently, Xiao Liu, who was obese and looked painful, walked into the ultrasound department of Hunan Provincial Second People's Hospital (Provincial Brain Hospital) .

The ultrasound doctor picked up the probe and saw ultrasound signs such as synovitis and double-track sign. He immediately asked the young man if he had a history of elevated uric acid. Xiao Liu said that he had found elevated uric acid during a physical examination last year, but he had never taken it seriously. The examination results showed that the patient had typical ultrasound features of gouty arthritis. After treatment such as lowering uric acid and relieving pain, Xiao Liu's condition improved.

Gout is caused by excessive production of uric acid in the blood or poor metabolism, which deposits in the joints, cartilage, synovium, etc. due to increased purine synthesis caused by eating high-purine foods such as meat and seafood, or slowing down purine metabolism due to drinking. Gout is a very painful disease, and its typical symptom is sudden onset of joint pain, with the first metatarsophalangeal joint of the big toe being the most susceptible site.

Liu Youyuan, director of the Ultrasound Department of Hunan Provincial People's Hospital No. 2 (Provincial Brain Hospital) , said that it is relatively easy to diagnose gout in a typical patient, but when the clinical manifestations are atypical, such as suspected patients with normal or slightly elevated blood uric acid levels and joint pain, ultrasound can serve as a powerful auxiliary diagnosis.

In traditional concepts, magnetic resonance imaging has good diagnostic effects on tendons, joints and other soft tissues, but due to its high price and low repeatability, it is not suitable for popularization in the diagnosis of gout patients. Ultrasound has the advantages of low price, non-invasiveness, high resolution and good repeatability.

Typical ultrasound findings in patients with gouty arthritis include the following:

1. "Double track sign", the formation principle is that urate is deposited on the surface of articular cartilage, forming an arc-shaped strong echo parallel to the bone surface;

2. "Gout stones", manifested as low echoes around joints or soft tissues or high echoes with low echo halos around them;

3. "Snowstorm sign" synovitis is manifested by low echoes in the soft tissue or around the joints mixed with a large number of strong point echoes.

In addition, ultrasound can also observe blood flow in gout-affected areas, determine whether there is bone erosion, assist in determining inflammatory activity and treatment effectiveness. For some patients, the "double-track sign" may disappear after uric acid-lowering treatment.

Musculoskeletal ultrasound makes the diagnosis of gout more visible. If sudden joint swelling, heat and pain occur, ultrasound examination can be performed in time to help identify the cause. At the same time, we remind everyone to develop a healthy lifestyle, drink less alcohol, eat less seafood, drink less hot soup, and keep yourself away from gout.

Hunan Medical Chat Special Author: Huang Lijuan, Ultrasound Department, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by YT)