Urate crystals deposition in the feet of overweight juveniles and those with symptomatic hyperuricemia: a dual-energy CT study

Sun, Nan; Zhong, Shiling; Li, Yunyan; Wu, Ling; Di, Yazhen

doi:10.1515/jpem-2015-0290

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…Meanwhile our previous research found that MSU crystal deposition can be observed in hyperuricemic children [5]. It suggests that some patients with HUA have developed joint disease, and it may significantly affect their quality of life.…”

Section: Introductionmentioning

confidence: 91%

Urate crystal deposition in hyperuricemic children: a dual energy computed tomography study

Ying

Wang²,

Li³

et al. 2021

Arch Med Sci

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IntroductionThe incidence of hyperuricemia (HUA) at younger ages is increasing along the coastal regions of China. This study aimed to compare the frequency of dual energy CT (DECT) urate crystal deposition between symptomatic hyperuricemic children and asymptomatic hyperuricemic children.Material and methodsFifty-six hyperuricemic children were divided into a Joint Group (n = 33) and an Asymptomatic Group (n = 23) according to whether they had a history of arthritis symptoms, which includes rapid onset monoarthritis with intense pain and swelling. We analyzed DECT scans of their feet from the Joint Group and the Asymptomatic Group and compared their clinical features.ResultsDECT urate deposits were observed in 28/33 (84.8%) children with symptomatic HUA and 14/23 (60.9%) with asymptomatic HUA. We found 60 areas of urate deposition in the Joint Group; DECT urate crystal deposition was most frequently observed in the first metatarsophalangeal (MTP) joint (30.0%), ankle joint (15.0%), and calcaneus (13.3%). 39 urate deposits were found in the Asymptomatic Group; DECT urate crystal deposition was most frequently observed in the calcaneus (25.6%), the first MTP joint (17.9%), and the first phalanx (15.4%).ConclusionsUrate deposition can occur in children with HUA, and these deposits occur more frequently in hyperuricemic children with a history of arthritis symptoms. Also, the urate deposition in the first MTP joint and calcaneus was more prevalent than in other joints. It is important to give more attention to hyperuricemic children.

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Section: Introductionmentioning

confidence: 91%

Urate crystal deposition in hyperuricemic children: a dual energy computed tomography study

Ying

Wang²,

Li³

et al. 2021

Arch Med Sci

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“…In addition, a complete blood count with differential and serum uric acid levels should be done every 6 months [ 111 ]. While there are no published data to evaluate the clinical significance of elevated uric acid levels associated with the use of diazoxide, studies in other populations have shown that chronic hyperuricemia in children can lead to monosodium urate deposits that may progress to gout, just as in adults [ 118 ]. Thus, we consider it important to screen for hyperuricemia in children treated with diazoxide given the reported 5% frequency of hyperuricemia in this population [ 109 ].…”

Section: Medical Managementmentioning

confidence: 99%

International Guidelines for the Diagnosis and Management of Hyperinsulinism

León¹,

Arnoux²,

Banerjee³

et al. 2023

Horm Res Paediatr

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Hyperinsulinism (HI) due to dysregulation of pancreatic beta-cell insulin secretion is the most common and most severe cause of persistent hypoglycemia in infants and children. In the 65 years since HI in children was first described, there has been a dramatic advancement in the diagnostic tools available, including new genetic techniques and novel radiologic imaging for focal HI, however; there have been almost no new therapeutic modalities since the development of diazoxide. Recent advances in neonatal research and genetics have improved our understanding of the pathophysiology of both transient and persistent forms of neonatal hyperinsulinism. Rapid turnaround of genetic test results combined with advanced radiologic imaging can permit identification and localization of surgically-curable focal lesions in a large proportion of children with congenital forms of HI, but are only available in certain centers in ‘developed’ countries. Diazoxide, the only drug currently approved for treating HI, was recently designated as an “essential medicine” by the World Health Organization but has been approved in only 16% of Latin American countries and remains unavailable in many under-developed areas of the world. Novel treatments for HI are emerging, but they await completion of safety and efficacy trials before being considered for clinical use. This international consensus statement on diagnosis and management of HI was developed in order to assist specialists, general pediatricians, and neonatologists in early recognition and treatment of HI with the ultimate aim of reducing the prevalence of brain injury caused by hypoglycemia. A previous statement on diagnosis and management of HI in Japan was published in 2017. The current document provides an updated guideline for management of infants and children with HI and includes potential accommodations for less-developed regions of the world where resources may be limited.

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“…In pediatric patients, chronic hyperuricemia is often associated with underlying comorbidities such as cardiovascular disease or kidney disease, inborn errors of purine metabolism, genetic disorders, or kidney transplantation [2][3][4][5][6][7][8][9][10][11][12][13]. Gout is relatively rare in the pediatric population, but diagnostic studies with dual energy computed tomography technology have shown that chronic sustained hyperuricemia in children can lead to monosodium urate deposits that may progress to gout, just as in adults [14][15][16]. Recent trends have shown that child obesity is increasing, which suggests a possible correlation to the prevalence of gout and hyperuricemia in pediatric patients and which parallels the increasing incidence of gouty arthritis at younger ages [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

et al. 2020

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Background Although gout is rare in children, chronic sustained hyperuricemia can lead to monosodium urate deposits progressing to gout, just as in adults. This study assessed prevalence and characteristics of gout and asymptomatic hyperuricemia, and incidence of gouty arthritis in the pediatric population, using data from Japanese health insurance claims. The diagnosis and treatment of pediatric gout and hyperuricemia were analyzed, and specific characteristics of those patients were assessed. Since Japanese guidelines recommend treatment with uric acid lowering drugs for asymptomatic hyperuricemia as well as for gout, these data were also used to investigate the real-world use of uric acid lowering drugs in a pediatric population. Methods This cross-sectional study was based on a 2016–2017 Japanese health insurance claims database, one of the largest epidemiology claims databases available in Japan, which included 356,790 males and 339,487 females 0–18 years of age. Outcomes were measured for prevalence, patient characteristics, treatment with uric acid lowering drugs for gout and asymptomatic hyperuricemia, and prevalence and incidence of gouty arthritis. Because uric acid can be elevated by some forms of chemotherapy, data from patients under treatment for malignancies were excluded from consideration. Results Total prevalence of gout and asymptomatic hyperuricemia in 0–18 year-olds was 0.040% (276/696,277 patients), with gout prevalence at 0.007% (48/696,277) and asymptomatic hyperuricemia at 0.033% (228/696,277). Prevalence of gout and asymptomatic hyperuricemia was highest in adolescent males, at 0.135% (176/130,823). The most common comorbidities for gout and asymptomatic hyperuricemia were metabolic syndrome at 42.8% (118/276) and kidney disease at 34.8% (96/276). Of the patients diagnosed with gout or asymptomatic hyperuricemia, 35.1% (97/276) were treated with uric acid lowering drugs. Gouty arthritis developed in 43.8% (21/48) of gout patients during the study, at an incidence of 0.65 flares/person-year. Conclusions Even the pediatric population could be affected by asymptomatic hyperuricemia, gout, and gouty arthritis, and uric acid lowering drugs are being used in this population even though those drugs have not been approved for pediatric indications. Such off-label use may indicate a potential need for therapeutic agents in this population. Trial registration UMIN000036029.

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Urate crystals deposition in the feet of overweight juveniles and those with symptomatic hyperuricemia: a dual-energy CT study

Abstract: Urate crystals deposition can be detected by dual-energy CT in the feet of symptomatic hyperuricemia juveniles. DECT can be a valuable diagnostic tool for helping diagnose in juvenile gout.

Cited by 8 publications

References 15 publications

Urate crystal deposition in hyperuricemic children: a dual energy computed tomography study

Urate crystal deposition in hyperuricemic children: a dual energy computed tomography study

International Guidelines for the Diagnosis and Management of Hyperinsulinism

Prevalence of gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

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