901 1 Clinica Reumatologica, Università Politecnica delle Marche, Ancona, Italy; 2 Department of Rheumatology, Antrim Hospital, Antrim, United Kingdom; 3 Unità Operativa di Reumatologia, Università di Pisa, Pisa, Italy; 4 Cattedra di Reumatologia, IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy; 5 Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy. Emilio Filippucci, MD Gary Meenagh, MD Andrea Delle Sedie, MD Garifallia Sakellariou, MD Annamaria Iagnocco, MD Lucrezia Riente, MD Marwin Gutierrez, MD Stefano Bombardieri, MD, Professor of Rheumatology Guido Valesini, MD, Professor of Rheumatology Carlomaurizio Montecucco, MD, Professor of Rheumatology Walter Grassi, MD, Professor of Rheumatology Please address correspondence to: Dr Emilio Filippucci, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale “C. Urbani”, Via dei Colli 52, 60035 Jesi (Ancona), Italy. E-mail: emilio_filippucci@yahoo.it Received and accepted on December 14, 2011. Clin Exp Rheumatol 2011; 29: 901-905. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2011. Competing interests: none declared. ABSTRACT Objective. This study aims to investi- gate the relationship between clinical and US findings together with the prev- alence and distribution of US findings indicative of monosodium urate (MSU) crystal deposition within the foot in pa- tients with gout. Methods. A total of 50 patients with gout attending the in-patient and the out-patient clinics of the Rheumatology Departments were prospectively en- rolled in this multi-centre study. Multi- planar examination of the following 15 joints was performed: talo-navicular, navicular-cuneiform (medial, interme- diate and lateral), calcaneo-cuboid, medial, intermediate and lateral cunei- form-metatarsal, cuboid-4th metatar- sal, cuboid-5th metatarsal and all five metatarsophalangeal (MTP) joints. Results. The following US findings were indicative of gout: enhancement of the superficial margin of the hyaline carti- lage, intra-articular tophus, and extra- articular tophus. In 46 patients, a total of 1380 foot joints were investigated. In 1309 joints that were not clinically in- volved, US detected signs indicative of joint inflammation in 9% (121/1309). Talo-navicular joint and the first MTP joint were the joints in which the high- est number of US findings were found at mid-foot and fore-foot, respectively. At MTP joint level, dorsal scans allowed the detection of a higher number of US findings indicative of joint inflamma- tion, and MSU crystal deposits rather than on the volar plane. Conclusion. This study demonstrated that US detected a higher number of inflamed foot joints than clinical exam- ination, and that the first MTP and the talo-navicular joints were the anatomic sites with the highest prevalence of US signs of MSU crystal aggregates. Introduction In recent times several studies have in- vestigated the role of ultrasound (US) in the rheumatological assessment of patients with gout (1-15). Highly spe- cific findings have been already been described by our group and other in- vestigators. Current evidence suggests that US is an accurate imaging tool for detect- ing signs of monosodium urate (MSU) crystal deposition. Some aspects of us- ing US in gout require further clarifi- cation, however including the relation- ship between clinical and US findings and the impact of these findings in the management of patients with gout. The present study was aimed at investi- gating the relationship between clinical and US findings, together with the prev- alence and distribution of US findings indicative of MSU crystal deposition within the foot in patients with gout. Methods Patients A total of 50 consecutive patients with a definite diagnosis of gout (16) attend- ing the in-patient and out-patient clin- ics of the Rheumatology Departments were prospectively enrolled in this multi-centre study. Patients with previ- ous joint surgery and/or history of se- vere trauma to the foot were excluded. Each centre was expected to recruit at least 10 patients. Four patients were not included because of the following reasons: two patients had undergone a surgical intervention, one had multi- ple metatarsal bony fractures and the last did not agree to participate in the study. Before the beginning of the study, the sonographers reached an agreement on the scanning protocol to adopt and on Imaging Ultrasound imaging for the rheumatologist XXXVI. Sonographic assessment of the foot in gout patients E. Filippucci 1 , G. Meenagh 2 , A. Delle Sedie 3 , G. Sakellariou 4 , A. Iagnocco 5 , L. Riente 3 , M. Gutierrez 1 , S. Bombardieri 3 , G. Valesini 5 , C. Montecucco 4 , W. Grassi 1