PANLAR Ultrasound Study Group Recommendations for the Use of Imaging in the Management of Patients with Gout

Marwin Gutierrez ¹, Carlos Pineda ¹, Janitzia Vazquez-Mellado ², Mario Moreno Alvarez ³, Javier Rosa ⁴, Anthony Reginato⁵, Mario Chavez ⁶, Magaly Alva Linares ⁷, Marcelo Audisio ⁸, José Alexandre Mendonca ⁹, Tomas Cazenave ¹⁰, Oscar Sedano ¹¹, Lucio Ventura Ríos ¹², Eugenio de Miguel ¹³, Gurjit Kaeley ¹⁴, Eduardo Scheines ¹⁰, Fritz Hofmann ¹⁵, Gabriel Aguilar ¹⁶, Christian Waimann ¹⁷, Florencia Marengo ¹⁷ and Santiago Ruta ¹⁸, ¹Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico, Mexico, Mexico, ²Rheumatology Department, Hospital General de Mexico, Mexico, Mexico, ³Rheumatology Department, Hospital General Luis Vernaza, Guayaquil, Ecuador., Guayaquil, Ecuador, ⁴Rheumatology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Argentina, Buenos Aires, Argentina, ⁵Division of Rheumatology, Providence VAMC, Associate Professor in Medicine, The Warren Alpert School of Medicine, Providence, ⁶Universidad Autónoma de Aguascalientes Aguascalientes, México., Aguascalientes, Mexico, ⁷Rheumatology Department, Hospital Edgardo Rebagliati Martins, Lima, Peru., Lima, Peru, ⁸Rheumatology Department, Hospital Nacional de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Argentina., Cordoba, Argentina, ⁹Rheumatology Department, Pontifical Catholic University of Campinas, Brazil, Campinas, Brazil, ¹⁰Rheumatology Section, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, Buenos Aires, Argentina, ¹¹Reumatology Section, Hospital Marino Molina Scippa, Lima, Perú, Lima, Peru, ¹²Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", México, Mexico, Mexico, ¹³Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain, ¹⁴Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL., Florida, ¹⁵Diagnostik Group, Puerto Vallarta, México., Puerto Vallarta, Mexico, ¹⁶Centro Diagnóstico Rossi, Buenos Aires, Argentina, Buenos Aires, Argentina, ¹⁷Rheumatology Unit, Hospital Dr. Héctor Cura, Olavarría, Argentina., Olavarria, Argentina, ¹⁸Rheumatology Department, Hospital San Martín de La Plata and Rheumatology Unit, Hospital Italiano de La Plata, Argentina., La Plata, Argentina

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Computed tomography (CT), Magnetic resonance imaging (MRI), radiography and gout, Ultrasound

Session Information

Date: Sunday, November 10, 2019

Title: Imaging Of Rheumatic Diseases Poster I

Session Type: Poster Session (Sunday)

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

Background/Purpose: Gout is a metabolic disease caused by deposition of monosodium urate (MSU) monohydrate crystals in different tissues. Imaging may be useful to evaluate the extent of MSU deposition, the presence of acute and chronic inflammation, and tissue structural damage. The aim of the current study was to develop evidence-based and expert opinion recommendations for the use of imaging techniques in the diagnosis, monitoring, prognosis and treatment of patients with gout.

Methods: A selected group of experts (rheumatologists, radiologists, rheumatologist sonographers, methodologists and statisticians) from different PANLAR countries were included in the gout imaging task force. Imaging modalities evaluated were: conventional radiography (CR), ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and dual-energy computed tomography (DECT). Seven clinical questions were selected using the Delphi technique with RAND/UCLA modified methodology. Each question was scored in a visual analogue scale from 1 to 9 (1: complete disagreement; 9: complete agreement). With the information obtained, questions were reformulated and re-evaluated using the same scoring system. One question did not reach agreement. Finally, six questions were selected. A systematic literature review was performed using Medline, LILACs, Embase and Cochrane databases from January 1966 to February 2018. The search resulted in a total of 8657 articles, of which 1957 were duplicated. Of the 6700 remaining, 6020 were excluded based on the title and/or summary, leaving 680 for full text review. After that, 639 were excluded, leaving a total of 41 articles as supporting evidence, by two independent reviewers (agreement 97%, kappa 0.91). Recommendations were developed by consensus following similar methodology utilized for clinical question selection. Such recommendations were graded according to levels of evidence from the Oxford Center of Medicine in 2011. Final recommendations were eventually presented to an independent committee including representatives from several PANLAR rheumatologist societies.

Results: Eight recommendations were developed for the use of imaging techniques in the diagnosis, monitoring, prognosis and treatment of patients with gout. The strength of each recommendation was established based on the evidence level as well as rate of agreement. Both gout imaging task force and independent committee agreed with the final recommendations (Table 1).

Conclusion: To the best of our knowledge, these are the first evidence-based and expert opinion recommendations for the use of imaging in patients with gout, providing some guidelines for their use in daily clinical practice.

Table

Disclosure: M. Gutierrez, None; C. Pineda, None; J. Vazquez-Mellado, None; M. Moreno Alvarez, None; J. Rosa, ABBVIE, 8, BRISTOL, 8, JANSSEN, 8, LILLY, 8, NOVARTIS, 8, PFIZER, 8; A. Reginato, Eli Lilly and Company, 5, Novartis, 5, Horizon, 5; M. Chavez, None; M. Alva Linares, None; M. Audisio, None; J. Mendonca, None; T. Cazenave, None; O. Sedano, None; L. Ventura Ríos, None; E. de Miguel, AbbVie, 2, 5, 8, BMS, 8, BMS, MSD, UCB, Roche, 8, MSD, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 8, UCB, 8; G. Kaeley, None; E. Scheines, None; F. Hofmann, None; G. Aguilar, None; C. Waimann, None; F. Marengo, None; S. Ruta, None.

To cite this abstract in AMA style:

Gutierrez M, Pineda C, Vazquez-Mellado J, Moreno Alvarez M, Rosa J, Reginato A, Chavez M, Alva Linares M, Audisio M, Mendonca J, Cazenave T, Sedano O, Ventura Ríos L, de Miguel E, Kaeley G, Scheines E, Hofmann F, Aguilar G, Waimann C, Marengo F, Ruta S. PANLAR Ultrasound Study Group Recommendations for the Use of Imaging in the Management of Patients with Gout [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/panlar-ultrasound-study-group-recommendations-for-the-use-of-imaging-in-the-management-of-patients-with-gout/. Accessed .

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