Chio Yokose1, Nicola Dalbeth2, Jie Wei1, Savvas Nicolaou3, F Joseph Simeone4, Scott Baumgartner5, Maple Fung5, Yuqing Zhang1, Hyon K Choi6. 1. Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA. 2. Department of Medicine, University of Auckland, Auckland, New Zealand. 3. Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada. 4. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 5. Formerly Ardea Biosciences Inc., San Diego, California, USA. 6. Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA. Electronic address: hchoi@mgh.harvard.edu.
Abstract
OBJECTIVES: To determine the clustering patterns of monosodium urate (MSU) crystal deposition and bone erosions among patients with gout requiring urate-lowering therapy (ULT) using dual-energy CT (DECT). METHODS: DECT scans of bilateral hands/wrists, feet/ankles, and knees were obtained on 153 patients with gout on allopurinol ≥300 mg daily for ≥3 months. Two radiologists assessed the images at pre-specified sites (15 in the hands/wrists, 12 in the feet/ankles, 4 in the knees). Clustering patterns of MSU crystal deposition and bone erosions were evaluated. RESULTS: Among 153 patients with gout (mean duration, 15 years) on allopurinol (mean duration, 5 years), MSU crystal deposition (67%) affected multiple sites in the hands/wrists, feet/ankles, and knees more often than would be expected by chance (p<0.001 for all 3 regions). In the feet/ankles, bone erosions were also observed in a clustered manner (p<0.001). Presence of MSU crystal deposition at a particular joint was most strongly associated with symmetric involvement of the same joint of the opposite extremity in the hands/wrists, feet/ankles, and knees (adjusted odds ratio (OR) 26.1, 46.9, and 9.9, respectively). Similarly, presence of erosions in the feet/ankles was highly symmetric (adjusted OR 91.4). Erosions were 8-fold more likely to be present in sites with MSU crystal deposition compared to those without. CONCLUSION: Among patients with longstanding gout on ULT, MSU crystal deposition and bone erosions affect multiple joints within the hands/wrists, feet/ankles, and knees in a highly symmetric manner. These radiologic data support the notion of MSU crystal deposition in gout as a symmetric polyarthropathy.
OBJECTIVES: To determine the clustering patterns of monosodium urate (MSU) crystal deposition and bone erosions among patients with gout requiring urate-lowering therapy (ULT) using dual-energy CT (DECT). METHODS: DECT scans of bilateral hands/wrists, feet/ankles, and knees were obtained on 153 patients with gout on allopurinol ≥300 mg daily for ≥3 months. Two radiologists assessed the images at pre-specified sites (15 in the hands/wrists, 12 in the feet/ankles, 4 in the knees). Clustering patterns of MSU crystal deposition and bone erosions were evaluated. RESULTS: Among 153 patients with gout (mean duration, 15 years) on allopurinol (mean duration, 5 years), MSU crystal deposition (67%) affected multiple sites in the hands/wrists, feet/ankles, and knees more often than would be expected by chance (p<0.001 for all 3 regions). In the feet/ankles, bone erosions were also observed in a clustered manner (p<0.001). Presence of MSU crystal deposition at a particular joint was most strongly associated with symmetric involvement of the same joint of the opposite extremity in the hands/wrists, feet/ankles, and knees (adjusted odds ratio (OR) 26.1, 46.9, and 9.9, respectively). Similarly, presence of erosions in the feet/ankles was highly symmetric (adjusted OR 91.4). Erosions were 8-fold more likely to be present in sites with MSU crystal deposition compared to those without. CONCLUSION: Among patients with longstanding gout on ULT, MSU crystal deposition and bone erosions affect multiple joints within the hands/wrists, feet/ankles, and knees in a highly symmetric manner. These radiologic data support the notion of MSU crystal deposition in gout as a symmetric polyarthropathy.
Authors: Sara Bayat; Opetaia Aati; Jürgen Rech; Mark Sapsford; Alexander Cavallaro; Michael Lell; Elizabeth Araujo; Christina Petsch; Lisa K Stamp; Georg Schett; Bernhard Manger; Nicola Dalbeth Journal: Arthritis Care Res (Hoboken) Date: 2016-06 Impact factor: 4.794