Dual-Energy CT of Urate Deposits in Costal Cartilage and Intervertebral Disks of Patients With Tophaceous Gout and Age-Matched Controls

Carr, Alexander R.; Doyle, Anthony; Dalbeth, Nicola; Aati, Opetaia; McQueen, Fiona

doi:10.2214/ajr.15.15356

Cited by 32 publications

(19 citation statements)

References 17 publications

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“…Novel findings, using DECT, have further indicated that, in the absence of gout, urate crystals deposit in costal cartilages and intervertebral disks in middle-aged men [ 17 ], and at several sites of axial and peripheral joint involvement in spondyloarthropathy and seronegative rheumatoid arthritis patients [ 18 , 19 ]. Nevertheless, the mechanism and tissue effects of deposited urate crystals in these conditions are unknown.…”

Section: Urate Crystal Deposits Often Remain Clinically Silentmentioning

confidence: 99%

What makes gouty inflammation so variable?

Terkeltaub

2017

BMC Med

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Acute gout arthritis flares contribute dominantly to gout-specific impaired health-related quality of life, representing a progressively increasing public health problem. Flares can be complex and expensive to treat, partly due to the frequent comorbidities. Unmet needs in gout management are more pressing given the markedly increasing gout flare hospital admission rates. In addition, chronic gouty arthritis can cause joint damage and functional impairment. This review addresses new knowledge on the basis for the marked, inherent variability of responses to deposited urate crystals, including the unpredictable and self-limited aspects of many gout flares. Specific topics reviewed include how innate immunity and two-signal inflammasome activation intersect with diet, metabolism, nutritional biosensing, the microbiome, and the phagocyte cytoskeleton and cell fate. The paper discusses the roles of endogenous constitutive regulators of inflammation, including certain nutritional biosensors, and emerging genetic and epigenetic factors. Recent advances in the basis of variability in responses to urate crystals in gout provide information about inflammatory arthritis, and have identified potential new targets and strategies for anti-inflammatory prevention and treatment of gouty arthritis.

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Section: Urate Crystal Deposits Often Remain Clinically Silentmentioning

confidence: 99%

What makes gouty inflammation so variable?

Terkeltaub

2017

BMC Med

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“…Lastly, gout is known to most frequently affect the first metatarsophalangeal joint, but it can involve other parts of the body. 10 11 With the advantage of DECT scans allowing to analyse multiple joint sites within the entire foot in a single scan, we were able to find MSU crystal deposits outside the metatarsophalangeal joints.…”

Section: Discussionmentioning

confidence: 96%

Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT

et al. 2018

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ObjectivesDual-energy CT (DECT) scan is a sensitive and specific tool used to visualise and quantify monosodium urate (MSU) crystal deposits in the joints. Few studies have examined MSU crystal deposits in patients with asymptomatic hyperuricemia (ie, hyperuricemia in the absence of gout) using DECT.MethodsWe conducted a prospective, non-interventional cross-sectional study to detect MSU crystal deposits on DECT scans among patients with asymptomatic hyperuricemia. We also examined patient factors associated with subclinical MSU crystal deposits. Out of 130 subjects aged ≥40 years with metabolic syndrome screened for serum uric acid (sUA) levels ≥6.5 mg/dL, 46 underwent a foot/ankle DECT scan.ResultsThe mean age of the study participants was 62 (±8) years, 41% were men and the mean sUA level was 7.8 (±1.0) mg/dL. Seven (15%) of 46 patients had MSU crystal deposits on DECT with a mean total volume of 0.13 (±0.14) cm3. In the univariable logistic regression analysis, older age had a significant association with presence of MSU crystal deposits (OR 1.20, 95% CI 1.03 to 1.39), but sUA did not (OR 1.36, 95% CI 0.63 to 2.95). In the univariable analysis, sUA levels showed a trend towards a modest linear association (β=0.11, P=0.09) with total volume of MSU crystal deposits.ConclusionsFifteen per cent of patients with asymptomatic hyperuricemia had subclinical MSU crystal deposits on foot/ankle DECT scans. Older age, but not sUA, was significantly associated with presence of subclinical MSU crystal deposits among patients with asymptomatic hyperuricemia. Clinical significance of these subclinical MSU crystal deposits needs to be determined.

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“…Carr et al found strong DECT signal intensity indicating MSU deposition in the costal cartilages and intervertebral disks of patients with chronic gout but interestingly also found similar findings in healthy age-matched male control subjects, but not young control subjects. 46 The findings suggest that physiologic MSU deposition may occur in these regions in middle-aged and older men.…”

Section: Dual-energy Computed Tomographymentioning

confidence: 88%

Advanced Imaging in the Diagnosis of Gout and Other Crystal Arthropathies

Teh

McQueen

Eshed³

et al. 2018

Semin Musculoskelet Radiol

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In recent years significant advances have been made in imaging techniques. Dual-energy computed tomography has revolutionized the ability to detect and quantify gout. The key ultrasound features of gout have been defined. Magnetic resonance imaging is an excellent modality for demonstrating the extent and severity of crystal arthropathies, but the findings may be nonspecific. This article summarizes the use of advanced imaging techniques in the diagnosis and assessment of gout and other crystal arthropathies.

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Dual-Energy CT of Urate Deposits in Costal Cartilage and Intervertebral Disks of Patients With Tophaceous Gout and Age-Matched Controls

Cited by 32 publications

References 17 publications

What makes gouty inflammation so variable?

What makes gouty inflammation so variable?

Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT

Advanced Imaging in the Diagnosis of Gout and Other Crystal Arthropathies

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