Relationship between structural joint damage and urate deposition in gout: a plain radiography and dual-energy CT study

Dalbeth, Nicola; Aati, Opetaia; Kalluru, Ramanamma; Gamble, Gregory D.; Horne, Anne; Doyle, Anthony; McQueen, Fiona

doi:10.1136/annrheumdis-2013-204273

Cited by 78 publications

(71 citation statements)

References 24 publications

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“…Two readers, blinded to the clinical variables and plain radiographic scores, evaluated the DECT scans for the presence and volumes of MSU crystal, independently. MSU crystal was considered present at each site only if reported by both readers and the average volume of MSU crystal was calculated [23]. …”

Section: Methodsmentioning

confidence: 99%

Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study

Zhu¹,

Li²,

Jia³

et al. 2017

Arthritis Res Ther

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BackgroundPrevious studies have revealed that ankylosing spondylitis (AS), as the progenitor of axial spondyloarthritis (AxSpA), has been characterized by the insidiously progressive nature of sacroiliitis and spondylitis. Dual-energy computed tomography (DECT) has recently been used to analyse the deposition of monosodium urate (MSU) crystals with higher sensitivity and specificity. However, it remains unclear whether the existence of the MSU crystal deposition detected by DECT at the sacroiliac joint in patients with AxSpA also is associated with the existing structural damage. Here, we performed this study to show the DECT MSU crystal deposits in AxSpA patients without coexisting gout and to ascertain the relationship between the MSU crystal deposition and the structural joint damage of sacroiliac joints.MethodsOne hundred and eighty-six AxSpA patients without coexisting gout were recruited. The plain radiographs of the sacroiliac joint were obtained, along with the DECT scans at the pelvis and the clinical variables. All statistics based on the left or right sacroiliac joint damage grading (0–4) were calculated independently. Bivariate analysis and ordinal logistic regression was performed between the clinical features and radiographic grades at the sacroiliac joint.ResultsAt the pelvis, large quantities of MSU crystal deposition were found in patients with AxSpA. The average MSU crystal volume at the left sacroiliac joint, the right sacroiliac joint, and the pelvis were 0.902 ± 1.345, 1.074 ± 1.878, and 5.272 ± 9.044 cm3, values which were correlated with serum uric acid concentrations (r = 0.727, 0.740, 0.896; p < 0.001). In bivariate analysis, wide clinical variables were associated with the changes in sacroiliac joint damage. Further, the AxSpA duration, BASFI score, and the volume of MSU crystal at both sides of sacroiliac joint were associated with the progress of radiographic grade at the sacroiliac joints in the ordinal logistic models (left AOR = 1.180, 3.800, 1.920; right AOR = 1.190, 3.034, 1.418; p < 0.01).ConclusionsLarge quantities of MSU crystal deposition detected by DECT were found at the pelvis in AxSpA patients without coexisting gout. In addition to AxSpA duration and BASFI score, the MSU crystal deposition at the sacroiliac joint is associated with the progress of radiographic grade at sacroiliac joints in those patients.

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Section: Methodsmentioning

confidence: 99%

Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study

Zhu¹,

Li²,

Jia³

et al. 2017

Arthritis Res Ther

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“…CT has shown that joints with intraosseous tophus are more likely to have features of abnormal new bone formation such as bony spurs, osteophytes, periosteal new bone formation, ankyloses and sclerosis [46]. In DECT studies, MSU crystals are frequently present in joints affected by radiographic damage in gout [47].…”

Section: Structural Consequences Of Tophaceous Goutmentioning

confidence: 98%

The Gouty Tophus: a Review

2015

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The tophus is the cardinal feature of advanced gout. This review summarises recent research into the biology, impact and treatment of tophaceous gout. Microscopically, tophi are chronic foreign body granuloma-like structures containing collections of monosodium urate (MSU) crystals surrounded by inflammatory cells and connective tissue. Extracellular trap formation mediated by neutrophil interactions with MSU crystals may be a central checkpoint in tophus formation. Gouty tophi impact on many aspects of health-related quality of life. Tophi are also implicated in the development of structural joint damage and increased mortality risk in people with gout. Effective treatment of tophaceous gout requires long-term urate-lowering therapy, ideally to achieve a serum urate concentration of <5 mg/dL (300 μmol/L). Recent advances in gout therapeutics have expanded urate-lowering therapy options for patients with severe tophaceous disease to allow faster regression of tophi, improved health-related quality of life and, potentially, improved structural outcomes.

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“…After presentation of the first gout flare, further flares frequently occur,20 and in the presence of untreated hyperuricaemia, these flares become more frequent, prolonged and polyarticular over time. In addition to the recurrent acute inflammatory flares, chronic gouty arthritis and gouty tophi may also develop, with risk of bone and joint damage 21. By contrast with the acute gout flares, gouty tophi are frequently painless without clinically apparent inflammation.…”

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confidence: 99%

Hyperuricaemia and gout: time for a new staging system?

2014

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The current widely used clinical staging system for hyperuricaemia and gout describes the symptomatology of gout, but does not capture key aspects of the pathological basis of the disease. We propose a new clinical staging system. Stage A: hyperuricaemia, but without evidence of monosodium urate (MSU) crystal deposition or symptoms of gout. Stage B: MSU crystal deposition by microscopy or advanced imaging, but without signs or symptoms of gout. Stage C: MSU crystal deposition with prior or current symptoms of acute gout flares. Stage D: advanced gout requiring specialist interventions. This proposed new staging system provides a clear focus on gout as a chronic disease of MSU crystal deposition, and provides a rational framework to test the role of screening and treatment of asymptomatic disease.

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Relationship between structural joint damage and urate deposition in gout: a plain radiography and dual-energy CT study

Abstract: MSU crystals are frequently present in joints affected by radiographic damage in gout. These findings support the concept that MSU crystals interact with articular tissues to influence the development of structural joint damage in this disease.

Cited by 78 publications

References 24 publications

Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study

Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study

The Gouty Tophus: a Review

Hyperuricaemia and gout: time for a new staging system?

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