J Rheum Dis.  2019 Apr;26(2):124-130. 10.4078/jrd.2019.26.2.124.

Relationship between Urate Crystal Deposits Detected by Dual-energy Computed Tomography and Bone Erosions in Symptomatic Gout Patients without Clinically Apparent Tophi

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea. leejisoo@ewha.ac.kr
  • 2Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea. mshjy@ewha.ac.kr

Abstract


OBJECTIVE
Dual-energy computed tomography (DECT) allows sensitive detection of monosodium urate (MSU) crystal deposits in gout. However, the role of MSU deposits on DECT during the disease process of gout is not clear. The aim of our study was to evaluate the relationship between joint damage and MSU deposits detected by DECT in symptomatic non-tophaceous gout.
METHODS
DECT scans of 51 gout patients without clinically apparent tophi were assessed. Individual ankle and foot joints and Achilles tendon insertion sites were evaluated for the presence of MSU deposits and bone erosions. The total volume of MSU crystal on DECT was quantified using an automated software program. Clinical and laboratory data at the time of the DECT evaluation were obtained from medical record.
RESULTS
MSU deposits were detected in 92.2% of the patients evaluated. Median number and total volume of MSU deposit per patient was 5.0 and 0.6 cm3, respectively. Bone erosion was found in 54.9% of patients. MSU deposits in the first (1st) metatarsophalangeal (MTP) joints were significantly associated with presence of bone erosions (odds ratio [OR] 3.77, 95% confidence interval [CI] 1.06~13.38, p=0.040). Older age and frequent gout attack were associated with development of bone erosion in patients with MSU deposits (OR 1.12 and 2.57, 95% CI 1.04~1.22 and 1.02~6.50, p-value 0.004 and 0.047, respectively).
CONCLUSION
MSU deposits and erosions were frequently detected by DECT in symptomatic non-tophaceous gout patients, and MSU deposits in 1st MTP joints were associated with presence of bone erosions especially in patients with older age and frequent gout attack.

Keyword

Gout; Monosodium urate; Erosion; Dual-energy computed tomography

MeSH Terms

Achilles Tendon
Ankle
Foot Joints
Gout*
Humans
Joints
Medical Records
Uric Acid*
Uric Acid

Figure

  • Figure 1. DECT of a 59-year old man with gout. Three-dimensional VRT image of both feet shows green MSU deposits adjacent right first MTP and left second MTP joints (A). Axial DECT image of both feet with small green microtophi (B). Coronal MPR DECT image presenting green microtophi around right first and left second MTP (C). Coronal MPR multi-de-tector CT image which shows erosion on right first MTP (arrow) (D). DECT: dual-energy computed tomography, VRT: volume rendering technique, MSU: monosodium urate, MTP: meta-tarsophalangeal, MPR: multi-planar reformation.


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