Relevant aspects of imaging in the diagnosis and management of gout

Abstract

Gout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population aging. In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for monosodium urate crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis. In these situations, imaging methods have a fundamental role, aiding in the diagnostic confirmation or excluding other possible differential diagnosis. Conventional radiographs are still the most commonly used method in gout patients' evaluation; nevertheless, this is not a sensitive method, since it detect only late alterations. In the last years, there have been several advances in imaging methods for gout patients. Ultrasound has shown a great accuracy in the diagnosis of gout, identifying monosodium urate deposits in the synovial membrane and articular cartilage, in detecting and characterizing tophi and in identifying tophaceous tendinopathy and enthesopathy. Ultrasound has also been able to show crystal deposition in patients with articular pain in the absence of a classical gout crisis. Computed tomography is an excellent method for detecting bone erosions, being useful in spine involvement. Dual-energy CT is a new method able to provide information about the chemical composition of tissues, with high accuracy in the identification of monosodium urate deposits, even in the early stages of the disease and in cases of difficult characterization. Magnetic resonance imaging is useful in the evaluation of deep tissues not accessible by ultrasound. Besides the diagnosis, with the emergence of new drugs that aim to reduce tophaceous burden, imaging methods have become useful tools in monitoring the treatment of patients with gout.

Ultrasound Characterization of Gouty Dactylitis

“…This finding suggests that tophus is not the major cause of gouty dactylitis and also supports the fact that dactylitis is not a chronic hallmark of the disease such as tophus. [4] Although, we have observed that higher levels of blood uric acid are present in patients with PD signal, it is even more relevant to underline the fact that tenosynovitis and joint effusion was present in patients with levels of uric acid below the theoretical target. This observation could be confusing and can be interpreted from two different points of view: First, we can assume that, as some studies have suggested, the therapeutic goal in gout is still not enough to prevent musculoskeletal damage.…”

“…The interpretation of findings was dichotomous in the determination of synovitis, tenosynovitis, and enthesopathy according to EULAR definition criteria. [10] The identification of tophi was made according to the definition of Fernandes et al [4] The overlapping of findings was counted independently at the moment of establishing the prevalence.…”

“…[1,2] Classically, the synovitis or tenosynovitis mediated by the deposit of microcrystals and the presence of trophy has been interpreted as the cause of gouty dactylitis. [4] There are, however, no etiological study based on imaging analysis. The prevalence of gouty dactylitis features, from the point of view of the ultrasound imaging is still unknown.…”

Impact of Clinical Presentation on Imaging Evaluation to Direct Effective Treatment Strategies

“…US can effectively identify crystal deposits related to gout and calcium pyrophosphate dihydrate. [54][55][56] In the pediatric population, US has been shown to have good agreement with MRI for evaluation of cartilage thickness in patients with juvenile idiopathic arthritis. [57][58][59] Meniscal Pathology…”

Relationship Between Arthritis And Muscular Strength In Older Women With Symptoms Of Sarcopenia

“…This causes elevated levels of uric acid in the blood leading to hyperuricemia, which is defined as serum uric acid levels surpassing urate blood solubility (>6.8 mg/dl) (Burke et al, 2015;De Avila Fernandes et al, 2017;Lawrence et al, 2008;Wertheimer, Morlock, & Becker, 2013).…”