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Abstract Number: 1225

Limits of Detection of Monosodium Urate Crystals in Synovial Fluid by Ultrasound

John FitzGerald1, Andrea Ramirez Cazares 2 and Veena Ranganath 2, 1UCLA, Los Angeles, CA, 2University of California Los Angeles, Los Angeles, CA

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: gout and crystals, Ultrasound

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Session Information

Date: Monday, November 11, 2019

Session Title: Metabolic & Crystal Arthropathies Poster II: Clinical Trials & Basic Science

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

Background/Purpose: To evaluate limits of detection of ultrasound to detect monosodium urate crystals suspended in synovial fluid.

Methods: Serial dilutions were made mixing liquid tophus aspirated from an olecranon bursa with crystal free synovial fluid aspirated from a patient with knee osteoarthritis. For each dilution, beginning with the undiluted liquid tophus aspirate, crystal free synovial fluid was mixed with each subsequent dilution in a 1:1 ratio creating dilutions from 1:1 to 1:1024. At each dilution, the MSU suspensions in eppendorf tubes were scanned with GE Logic linear probe settings ranging from low to high frequency as needed for optimal imaging and penetration. Compensated polarized light microscopy images at 10x and 40x were obtained for each dilution.

Results: Ultrasound evidence of MSU crystals (snowstorm appearance) were still evident in serial dilutions up until 1:128. Corresponding histology imaged by compensated light microscopy revealed that large crystal aggregates were rare but there were still a high number of crystals (~100) per low power field. Further dilutions resulted in ultrasound images that were indistinguishable from crystal free aspirates of synovial fluid despite persistence of lower frequency MSU crystals.

Conclusion: Ultrasound is sensitive for detecting modest frequency of MSU crystals suspended in synovial fluid. Never-the-less, MSU crystals are still present in synovial fluid beyond ultrasound detection.

Figure 1: Serial dilutions of liquid tophus.


Disclosure: J. FitzGerald, None; A. Ramirez Cazares, None; V. Ranganath, genentech, 2, bristol meyer squibb, 2, 5, pfizer, 2, mallinckrodt, 2.

To cite this abstract in AMA style:

FitzGerald J, Ramirez Cazares A, Ranganath V. Limits of Detection of Monosodium Urate Crystals in Synovial Fluid by Ultrasound [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/limits-of-detection-of-monosodium-urate-crystals-in-synovial-fluid-by-ultrasound/. Accessed February 3, 2023.
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