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Dalbeth N, Botson J, Saag K, Kumar A, Padnick-Silver L, LaMoreaux B, Becce F. Monosodium urate crystal depletion and bone erosion remodeling during pegloticase treatment in patients with uncontrolled gout: Exploratory dual-energy computed tomography findings from MIRROR RCT. Joint Bone Spine 2024; 91:105715. [PMID: 38447697 DOI: 10.1016/j.jbspin.2024.105715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/19/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Monosodium-urate (MSU) crystal deposits can be visualized and quantified with dual-energy CT (DECT). Pegloticase lowers serum urate (SU) in uncontrolled gout patients, with methotrexate (MTX) co-therapy recommended to increase SU-lowering response rate and decrease infusion reaction risk. The literature on serial DECT-imaging during pegloticase+MTX co-therapy is sparse, with only 2 prior cases of rapid MSU deposition depletion with subsequent bone-erosion remodeling reported from a small open-label trial. Here, we report DECT findings during pegloticase treatment in a larger number of patients from a randomized controlled trial to confirm bone-erosion remodeling that follows MSU depletion with pegloticase. The influence of length-of-therapy is also explored. METHODS Patients received pegloticase (8mg every 2weeks)+MTX (15mg/week orally) or pegloticase+placebo (PBO) during the MIRROR RCT trial. A subset underwent DECT-imaging on Day1 (first pegloticase infusion) and at Weeks 14, 24, and 52. Patients with paired baseline-Week 52 images were included. Imaged regions with baseline MSU-crystal volume (VMSU)<0.5cm3 were excluded to minimize artifact contributions. VMSU and bone-erosion remodeling were assessed. RESULTS Eight patients (6 MTX, 2 PBO) were included. Included patients had received 52weeks (5 MTX), 42weeks (1 PBO), and 6weeks (1 MTX, 1 PBO) of pegloticase therapy. Patients who prematurely discontinued pegloticase maintained SU<6mg/dL on allopurinol (n=2)/febuxostat (n=1). At Week 52, VMSU had markedly decreased in both the pegloticase+MTX and pegloticase+PBO treatment groups, with faster depletion during pegloticase therapy. Bone-erosion remodeling was observed in 29/42 (69%) evaluated erosions: 29 (69%) size decrease, 4 (9.5%) recortication, 3 (7.1%) new bone formation. CONCLUSION Rapid VMSU depletion during pegloticase therapy was observed with concomitant bone remodeling within 1year. Following pegloticase discontinuation, VMSU reduction slowed or stopped even when SU was maintained<6mg/dL with oral ULT. CLINICAL TRIAL REGISTRATION NCT03994731.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, M&HS Building 507, 28 Park Ave. Grafton, 1023 Auckland, New Zealand
| | - John Botson
- Orthopedic Physicians Alaska, 3801 Lake Otis Parkway, 99508 Anchorage, AK, United States
| | - Kenneth Saag
- University of Alabama at Birmingham, 2000 6th Ave. South, Floor 3, 35233 Birmingham, AL, United States
| | - Ada Kumar
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States
| | - Lissa Padnick-Silver
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States.
| | - Brian LaMoreaux
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
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Jarraya M, Roemer F, Kwoh CK, Guermazi A. Crystal arthropathies and osteoarthritis-where is the link? Skeletal Radiol 2023; 52:2037-2043. [PMID: 36538066 DOI: 10.1007/s00256-022-04246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Osteoarthritis (OA) is one of the leading causes of disability worldwide. As our understanding of OA progressively has moved from a purely mechanical "wear and tear" concept toward a complex multi-tissue condition in which inflammation plays a central role, the possible role of crystal-induced inflammation in OA incidence and progression may be relevant. In addition to gout, which affects 4% of the US population, basic calcium phosphate and calcium pyrophosphate deposition both may induce joint inflammation and may play a role in pain in OA. This narrative review article discusses the possible mechanisms underlying the associations between crystal-induced arthropathies and OA, and the important implications of these for clinical practice and future research.
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Affiliation(s)
- Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, YAW 6044, Boston, MA, 02114, USA.
| | - Frank Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - C Kent Kwoh
- Division of Rheumatology, The University of Arizona, Tucson, AZ, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, VA Boston Healthcare System, West Roxbury, MA, USA
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3
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Schlesinger N, Pérez-Ruiz F, Lioté F. Mechanisms and rationale for uricase use in patients with gout. Nat Rev Rheumatol 2023; 19:640-649. [PMID: 37684360 DOI: 10.1038/s41584-023-01006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 09/10/2023]
Abstract
Xanthine oxidase inhibitors such as allopurinol and febuxostat have been the mainstay urate-lowering therapy (ULT) for treating hyperuricaemia in patients with gout. However, not all patients receiving oral ULT achieve the target serum urate level, in part because some patients cannot tolerate, or have actual or misconceived contraindications to, their use, mainly due to comorbidities. ULT dosage is also limited by formularies and clinical inertia. This failure to sufficiently lower serum urate levels can lead to difficult-to-treat or uncontrolled gout, usually due to poorly managed and/or under-treated gout. In species other than humans, uricase (urate oxidase) converts urate to allantoin, which is more soluble in urine than uric acid. Exogenic uricases are an exciting therapeutic option for patients with gout. They can be viewed as enzyme replacement therapy. Uricases are being used to treat uncontrolled gout, and can achieve rapid reduction of hyperuricaemia, dramatic resolution of tophi, decreased chronic joint pain and improved quality of life. Availability, cost and uricase immunogenicity have limited their use. Uricases could become a leading choice in severe and difficult-to-treat gout as induction and/or debulking therapy (that is, for lowering of the urate pool) to be followed by chronic oral ULT. This Review summarizes the evidence regarding available uricases and those in the pipeline, their debulking effect and their outcomes related to gout and beyond.
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Affiliation(s)
- Naomi Schlesinger
- Division of Rheumatology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Fernando Pérez-Ruiz
- Rheumatology Division, Cruces University Hospital, Vizcaya, Spain
- Arthritis Investigation Group, Biocruces-Bizkaia Health Research Institute, Vizcaya, Spain
- Medicine Department, Medicine and Nursing School, University of the Basque Country, Biskay, Spain
| | - Frédéric Lioté
- Université Paris Cité, UFR de Médecine, Paris, France
- Department of Rheumatology, DMU Locomotion, AP-HP Nord & Inserm UMR 1132, Bioscar (Centre Viggo Petersen), Hôpital Lariboisière, Paris, France
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Legrand J, Marzin C, Neogi T, Norberciak L, Budzik JF, Pascart T. Associations of Changes in Knee Hyaline Cartilage Composition Measured With Dual-Energy Computed Tomography in Gout, Aging and Osteoarthritis. Cartilage 2023:19476035231172152. [PMID: 37312537 DOI: 10.1177/19476035231172152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE To characterize dual-energy computed tomography (DECT) changes depicting hyaline cartilage changes in gout patients with and without osteoarthritis (OA) and in comparators without gout. DESIGN Patients with suspected crystal-associated arthropathy were enrolled and underwent bilateral DECT scans of the knees. Standardized regions of interest were defined in the femorotibial hyaline cartilage. Five DECT parameters were obtained: CT numbers in Hounsfield units (HU) at 80 and 140 kV, the electron density (Rho), the effective atomic number (Zeff), and the dual-energy index (DEI). Zones were compared between patients with gout, with and without knee OA, and between patients with gout and comparators without gout, after adjustment for confounders. RESULTS A total of 113 patients with gout (mean age 63.5 ± 14.3 years) and 15 comparators without gout (mean age 75.8 ± 11.5 years) were included, n = 65 (51%) had knee OA, and 466 zones of hyaline cartilage were analyzed. Older age was associated with lower attenuations at 80 kV (P < 0.01) and 140 kV (P < 0.01), and with Rho (P < 0.01). OA was characterized by lower attenuation at 140 kV (P = 0.03), but the lower Rho was nonsignificant after adjustment for confounders. In gout, hyaline cartilage exhibited lower Rho values (adjusted P = 0.04). Multivariable coefficients of association with Rho were -0.21 [-0.38;-0.04] (P = 0.014) for age, -4.15 [-9.0;0.7] (P = 0.093) for OA and 0.73 [-0.1;1.56] (P = 0.085) for monosodium urate volume. CONCLUSION Gout was associated with DECT-detected changes in cartilage composition, similar to those observed in older patients, with some similarities and some differences to those seen in OA. These results suggest the possibility of potential DECT biomarkers of OA.
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Affiliation(s)
- Julie Legrand
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- Imaging Department, Saint-Philibert Hospital, Lomme, France
| | - Claire Marzin
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
| | - Tristan Pascart
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
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Xu H, Zhang B, Chen Y, Zeng F, Wang W, Chen Z, Cao L, Shi J, Chen J, Zhu X, Xue Y, He R, Ji M, Hua Y. Type II collagen facilitates gouty arthritis by regulating MSU crystallisation and inflammatory cell recruitment. Ann Rheum Dis 2023; 82:416-427. [PMID: 36109143 DOI: 10.1136/ard-2022-222764] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Increasing evidence suggests that impaired cartilage is a substantial risk factor for the progression from hyperuricaemia to gout. Since the relationship between cartilage matrix protein and gout flares remains unclear, we investigated its role in monosodium urate (MSU) crystallisation and following inflammation. METHODS Briefly, we screened for cartilage matrix in synovial fluid from gouty arthritis patients with cartilage injuries. After identifying a correlation between crystals and matrix molecules, we conducted image analysis and classification of crystal phenotypes according to their morphology. We then evaluated the differences between the cartilage matrix protein-MSU complex and the pure MSU crystal in their interaction with immune cells and identified the related signalling pathway. RESULTS Type II collagen (CII) was found to be enriched around MSU crystals in synovial fluid after cartilage injury. Imaging analysis revealed that CII regulated the morphology of single crystals and the alignment of crystal bows in the co-crystalline system, leading to greater phagocytosis and oxidative stress in macrophages. Furthermore, CII upregulated MSU-induced chemokine and proinflammatory cytokine expression in macrophages, thereby promoting the recruitment of leucocytes. Mechanistically, CII enhanced MSU-mediated inflammation by activating the integrin β1(ITGB1)-dependent TLR2/4-NF-κB signal pathway. CONCLUSION Our study demonstrates that the release of CII and protein-crystal adsorption modifies the crystal profile and promotes the early immune response in MSU-mediated inflammation. These findings open up a new path for understanding the relationship between cartilage injuries and the early immune response in gout flares.
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Affiliation(s)
- HanLin Xu
- Department of Sports Medicine, Huashan Hospital,Fudan University, Shanghai, China
| | - Bohan Zhang
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Yiwu Research Institute, Fudan University, Shanghai, China
| | - Yaxin Chen
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Yiwu Research Institute, Fudan University, Shanghai, China
| | - Fengzhen Zeng
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Wenjuan Wang
- Department of Sports Medicine, Huashan Hospital,Fudan University, Shanghai, China
| | - Ziyi Chen
- Department of Sports Medicine, Huashan Hospital,Fudan University, Shanghai, China
| | - Ling Cao
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Shi
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital,Fudan University, Shanghai, China
| | - Xiaoxia Zhu
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Xue
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui He
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - MinBiao Ji
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Yiwu Research Institute, Fudan University, Shanghai, China
| | - YingHui Hua
- Department of Sports Medicine, Huashan Hospital,Fudan University, Shanghai, China
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Jia E, Li Z, Geng H, Zhu H, Wang Y, Lin F, Jiang Y, Zhang J. Neutrophil extracellular traps induce the bone erosion of gout. BMC Musculoskelet Disord 2022; 23:1128. [PMID: 36567343 PMCID: PMC9791768 DOI: 10.1186/s12891-022-06115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the relationships between monosodium urate (MSU) crystals -induced neutrophil extracellular traps (NETs) and bone erosion in gout. METHODS Animal models were used to study the relationship between NETs induced by MSU crystals and bone erosion. Neutrophils were treated with MSU crystals to induce NETs. The osteoblasts-like cells (OB) were then treated with NETs, and the supernatant was co-incubated with osteoclasts-like cells (OC). The NETs were digested with DNase, and the neutrophil elastase (NE) was inhibited with sivelestat sodium. Cell viability, mRNA, and protein expression were also assessed. RESULTS After treating OB with NETs, the cell viability decreased. Yet, after digesting the DNA and inhibiting NE, the viability was moderately improved. The expression level of osteoprotegerin (OPG) and alkaline phosphatase (ALP) was up-regulated, while the expression level of receptor activator of nuclear factor kappa-B ligand (RANKL) was down-regulated in the sivelestat sodium + MSU group compared with MSU group. The number of OC was significantly elevated. In contrast, the number of OB was not increased in the tibia after establishing the gout model. The supernatant obtained from OB was treated with NETs promoting OC differentiation. The expression level of receptor activator of nuclear factor kappa-B (RANK), tartrate-resistant acid phosphatase (TRAP), and cathepsin K (Cst K) was up-regulated in the MSU group compared with the normal control (NC) group. CONCLUSION NETs induced by MSU crystals could inhibit osteoblasts viability and enhance the activity of osteoclasts.
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Affiliation(s)
- Ertao Jia
- grid.411866.c0000 0000 8848 7685The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China ,The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China ,grid.411866.c0000 0000 8848 7685The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital; and the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China
| | - Zhiling Li
- grid.411866.c0000 0000 8848 7685The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hongling Geng
- grid.411866.c0000 0000 8848 7685The Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haiqiong Zhu
- grid.410745.30000 0004 1765 1045Shenzhen Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Shenzhen, China
| | - Yadong Wang
- The Department of Urology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Feng Lin
- The Department of Urology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yubao Jiang
- grid.411866.c0000 0000 8848 7685The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China ,The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jianyong Zhang
- grid.411866.c0000 0000 8848 7685The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China ,The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Uricase-Deficient Larval Zebrafish with Elevated Urate Levels Demonstrate Suppressed Acute Inflammatory Response to Monosodium Urate Crystals and Prolonged Crystal Persistence. Genes (Basel) 2022; 13:genes13122179. [PMID: 36553446 PMCID: PMC9777727 DOI: 10.3390/genes13122179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Gout is caused by elevated serum urate leading to the deposition of monosodium urate (MSU) crystals that can trigger episodes of acute inflammation. Humans are sensitive to developing gout because they lack a functional urate-metabolizing enzyme called uricase/urate oxidase (encoded by the UOX gene). A hallmark of long-standing disease is tophaceous gout, characterized by the formation of tissue-damaging granuloma-like structures ('tophi') composed of densely packed MSU crystals and immune cells. Little is known about how tophi form, largely due to the lack of suitable animal models in which the host response to MSU crystals can be studied in vivo long-term. We have previously described a larval zebrafish model of acute gouty inflammation where the host response to microinjected MSU crystals can be live imaged within an intact animal. Although useful for modeling acute inflammation, crystals are rapidly cleared following a robust innate immune response, precluding analysis at later stages. Here we describe a zebrafish uox null mutant that possesses elevated urate levels at larval stages. Uricase-deficient 'hyperuricemic' larvae exhibit a suppressed acute inflammatory response to MSU crystals and prolonged in vivo crystal persistence. Imaging of crystals at later stages reveals that they form granuloma-like structures dominated by macrophages. We believe that uox-/- larvae will provide a useful tool to explore the transition from acute gouty inflammation to tophus formation, one of the remaining mysteries of gout pathogenesis.
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Dalbeth N, Becce F, Botson JK, Zhao L, Kumar A. Dual-energy CT assessment of rapid monosodium urate depletion and bone erosion remodelling during pegloticase plus methotrexate co-therapy. Rheumatology (Oxford) 2022; 61:4898-4904. [PMID: 35293984 PMCID: PMC9707016 DOI: 10.1093/rheumatology/keac173] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Pegloticase rapidly lowers serum urate in uncontrolled/refractory gout patients, with ≥1 tophus resolution in 70% of pegloticase responders and 28% of non-responders. Dual-energy computed tomography (DECT) non-invasively detects MSU deposition, including subclinical deposition, quantifies MSU volumes and depicts bone erosions. This report presents DECT findings in MIRROR open-label trial participants receiving pegloticase+MTX co-therapy. METHODS Serial DECT scans were obtained during pegloticase (8 mg biweekly infusions)+oral MTX (15 mg/week) co-therapy. Bilateral hand/wrist, elbow, foot/ankle and knee images were analysed with default post-processing settings. MSU volumes were quantified and bone erosions were identified and evaluated for remodelling (decreased size, sclerosis, new bone formation). DECT and physical examination findings were compared. RESULTS 2 patients underwent serial DECT. Patient 1 (44-year-old male) completed 52 weeks of pegloticase+MTX co-therapy (26 infusions). Baseline examination detected 4 tophus-affected joints while DECT identified 73 MSU-affected joints (total MSU volume: 128.76 cm3). At end-of-treatment, there were no clinically-affected joints and 4 joints with DECT-detected MSU deposition. MSU volume decreased by 99% and bone erosion remodelling was evident. Patient 2 (51-year-old male) had 10 weeks of therapy (5 infusions), discontinuing because of urate-lowering response loss. Baseline examination detected 7 tophus-affected joints while DECT identified 55 MSU-affected joints (total MSU volume: 59.20 cm3). At end-of-treatment, there were 5 clinically affected joints and 42 joints with DECT-detected MSU deposition. MSU volume decreased by 58% and bone erosion remodelling was evident. CONCLUSION DECT detected subclinical MSU deposition and quantified changes over time. Rapid tophus resolution and bone erosion remodelling occurred during pegloticase+MTX co-therapy. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03635957.
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Affiliation(s)
- Nicola Dalbeth
- Correspondence to: Nicola Dalbeth, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Waipapa Taumata Rau, Room 502-201D, 85 Park Road, Grafton, Auckland 1023, New Zealand. E-mail:
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Lin Zhao
- Medical Affairs, Horizon Therapeutics plc, Deerfield, IL, USA
| | - Ada Kumar
- Medical Affairs, Horizon Therapeutics plc, Deerfield, IL, USA
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Rosas S, Zuskov A, Luo TD, Roche MW, Emory CL, Plate JF. Gout As a Predictor of Total Knee Arthroplasty Outcomes and Costs. J Knee Surg 2022; 35:362-366. [PMID: 32838460 DOI: 10.1055/s-0040-1715098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gout is the most common inflammatory arthritis and affects approximately 4% of the U.S. population. As the prevalence of gout and the number of total knee arthroplasties (TKAs) performed continue to increase, the literature on TKA in patients with gout remains scant. The purpose of this study was to evaluate the outcomes of patients with gout following TKA at a population level, that is, how patient with gout fair after TKA. We hypothesized that patients with gout have higher rates of complications and higher costs compared with controls. A case-control study was designed to evaluate two cohorts of Medicare patients who underwent TKA whose only distinguishing feature was the presence or absence of gout. Matching was performed to decrease confounding at a 1:1 ratio based on age, gender, and Charlson comorbidity index (CCI), (10-year survival predictor). The Medicare standard analytical files were queried through International Classification of Disease and current procedural terminology codes. A total of 15,238 patients were evaluated with 7,619 in each cohort. There were no age, gender, or CCI differences and 57.4% were females. Day of surgery and 90-day post-surgery costs were both significantly greater in those with gout (p < 0.001 for both). Multivariate analysis revealed that gout patients had increased odds of infection (odds ratio [OR] 1.229, p = 0.019), cardiac arrest (OR 1.354, p = 0.002), pneumonia (OR 1.161, p < 0.001), hematoma (OR 1.204, p = 0.002), and development of capsulitis (OR 1.208, p = 0.012). Nonetheless these patients had a decreased risk of pulmonary emboli (OR 0.835, p = 0.016). Our results support our hypothesis that patients with gout have higher rates of postoperative complications and increased day of surgery and 90-day costs of care after TKA. Given the high prevalence of gout in the United States, additional study on the utility of preoperative gout optimization for TKA patients is warranted. The level of evidence of this study is III, and it is a retrospective case-control study.
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Affiliation(s)
- Samuel Rosas
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Andrey Zuskov
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Tianyi David Luo
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Martin W Roche
- Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
| | - Cynthia L Emory
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
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Dalbeth N, Doyle AJ, Billington K, Gamble GD, Tan P, Latto K, Parshu Ram T, Narang R, Murdoch R, Bursill D, Mihov B, Stamp LK, Horne A. Intensive serum urate lowering with oral urate-lowering therapy for erosive gout: A randomized double-blind controlled trial. Arthritis Rheumatol 2021; 74:1059-1069. [PMID: 34927391 DOI: 10.1002/art.42055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/02/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether intensive serum urate lowering results in improved bone erosion scores in erosive gout. METHODS Two-year, double-blind, randomized, controlled trial of 104 participants with erosive gout on oral urate-lowering therapy (ULT) and serum urate ≥ 0.30mmol/L was undertaken. Participants were randomly assigned to serum urate target <0.20mmol/L (intensive target) or <0.30mmol/L (standard target, according to rheumatology guidelines). Oral ULT was titrated to target using a standardized protocol (using maximum approved doses of allopurinol, probenecid, febuxostat, and benzbromarone). The primary endpoint was total CT erosion score. OMERACT gout core outcome domains were secondary endpoints. RESULTS Although the serum urate was significantly lower in the intensive target group compared to the standard target group (P=0.002), fewer participants in the intensive group achieved the randomized serum urate target (at Year 2, 62% vs 83%, P<0.05). The intensive target group required higher allopurinol doses (mean (SD) 746 (210) mg/day vs 496 (185) mg/day, P<0.001), and used more combination therapy (P=0.0004). Small increases in CT erosion scores were observed in both groups over two years, with no between-group difference (P=0.20). OMERACT core outcome domains (gout flares, tophus, pain, patient global assessment, health-related quality of life, and activity limitation) improved in both groups, with no between-group differences. Adverse event and serious adverse event rates were similar between groups. CONCLUSION Compared with a serum urate target below 0.30mmol/L, more intensive serum urate-lowering is difficult to achieve with oral ULT, leads to high medication burden, and does not improve bone erosion scores in erosive gout.
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Affiliation(s)
- Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony J Doyle
- Department of Radiology, Auckland District Health Board.,Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Greg D Gamble
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul Tan
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kieran Latto
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thrishila Parshu Ram
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ravi Narang
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachel Murdoch
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Bursill
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Borislav Mihov
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Anne Horne
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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11
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Liu X, Zhang X, Mo S, Liang D, Li B, Zhu J. Factors Associated with Bone Erosion in Patients with Gout: A Dual-Energy Gemstone Spectral Imaging Computed Tomography Study. Mod Rheumatol 2021; 32:1170-1174. [PMID: 34918119 DOI: 10.1093/mr/roab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to assess the factors influencing bone erosion in patients with gout using dual-energy gemstone spectral imaging CT. METHODS We compared the clinical data, laboratory indices, and tissue urate levels at the monosodium urate (MSU)-bone interface measured by dual-energy gemstone spectral imaging computed tomography of 87 gout patients with (n=41) and without (n=46) bone erosion. Logistic regression analysis was used to investigate the risk factors associated with bone erosion. RESULTS In total, 47.1% of patients with gout had bone erosion. The disease duration, serum uric acid, tissue urate levels, and the presence of tophi were significantly higher (p<0.05) in gout patients with bone erosion than in those without bone erosion. Longer disease duration (OR=1.11, 95% CI: 1.00-1.24, p<0.05) and increased tissue urate levels (OR=1.01, 95% CI: 1.00-1.02, p<0.05) were independently associated with bone erosion. Tissue urate levels at the MSU-bone interface were correlated with the presence of tophi (r=0.62, p<0.001), bone erosion (r=0.51, p<0.001), renal calculus (r=0.24, p=0.03), and serum uric acid levels (r=0.23, p=0.03). CONCLUSION This study found that longer disease duration and elevated tissue urate concentrations at the MSU-bone interface were associated with bone erosion in patients with gout.
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Affiliation(s)
- Xiaofei Liu
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Xiaohuan Zhang
- Department of Radiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Shiyan Mo
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Dongfeng Liang
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Department of Rheumatology and Immunology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Baige Li
- Department of Radiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jian Zhu
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Department of Rheumatology and Immunology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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12
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Son CN, Cai K, Stewart S, Ferrier J, Billington K, Tsai YJJ, Bardin T, Horne A, Stamp LK, Doyle A, Dalbeth N. Development of a radiographic scoring system for new bone formation in gout. Arthritis Res Ther 2021; 23:296. [PMID: 34876237 PMCID: PMC8653557 DOI: 10.1186/s13075-021-02683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Features of new bone formation (NBF) are common in tophaceous gout. The aim of this project was to develop a plain radiographic scoring system for NBF in gout. Methods Informed by a literature review, scoring systems were tested in 80 individual 1st and 5th metatarsophalangeal joints. Plain radiography scores were compared with computed tomography (CT) measurements of the same joints. The best-performing scoring system was then tested in paired sets of hand and foot radiographs obtained over 2 years from an additional 25 patients. Inter-reader reproducibility was assessed using intraclass correlation coefficients (ICC). NBF scores were correlated with plain radiographic erosion scores (using the gout-modified Sharp-van der Heijde system). Results Following a series of structured reviews of plain radiographs and scoring exercises, a semi-quantitative scoring system for sclerosis and spur was developed. In the individual joint analysis, the inter-observer ICC (95% CI) was 0.84 (0.76–0.89) for sclerosis and 0.81 (0.72–0.87) for spur. Plain radiographic sclerosis and spur scores correlated with CT measurements (r = 0.65–0.74, P < 0.001 for all analyses). For the hand and foot radiograph sets, the inter-observer ICC (95% CI) was 0.94 (0.90–0.98) for sclerosis score and 0.76 (0.65–0.84) for spur score. Sclerosis and spur scores correlated highly with plain radiographic erosion scores (r = 0.87 and 0.71 respectively), but not with change in erosion scores over 2 years (r = −0.04–0.15). Conclusion A semi-quantitative plain radiographic scoring method for the assessment of NBF in gout is feasible, valid, and reproducible. This method may facilitate consistent measurement of NBF in gout. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02683-9.
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Affiliation(s)
- Chang-Nam Son
- Keimyung University School of Medicine, Daegu, South Korea. .,Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Ken Cai
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sarah Stewart
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - John Ferrier
- Department of Radiology, Auckland District Health Board, Auckland, New Zealand
| | - Karen Billington
- Department of Radiology, Auckland District Health Board, Auckland, New Zealand
| | - Yun-Jung Jack Tsai
- Department of Radiology, Auckland District Health Board, Auckland, New Zealand
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière, Paris, France
| | - Anne Horne
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Anthony Doyle
- Department of Radiology with Anatomy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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13
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Abstract
Urate is the end-product of the purine metabolism in humans. The dominant source of urate is endogenous purines and the remainder comes through diet. Approximately two thirds of urate is eliminated via the kidney with the rest excreted in the feces. While the transporter BCRP, encoded by ABCG2, has been found to play a role in both the gut and kidney, SLC22A12 and SLC2A9 encoding URAT1 and GLUT9, respectively, are the two transporters best characterized. Only 8-12% of the filtered urate is excreted by the kidney. Renal elimination of urate depends substantially on specific transporters, including URAT1, GLUT9 and BCRP. Studies that have assessed the biologic effects of urate have produced highly variable results. Although there is a suggestion that urate may have anti-oxidant properties in some circumstances, the majority of evidence indicates that urate is pro-inflammatory. Hyperuricemia can result in the formation of monosodium urate (MSU) crystals that may be recognized as danger signals by the immune system. This immune response results in the activation of the NLRP3 inflammasome and ultimately in the production and release of interleukin-1β, and IL-18, that mediate both inflammation, pyroptotic cell death, and necroinflammation. It has also been demonstrated that soluble urate mediates effects on the kidney to induce hypertension and can induce long term epigenetic reprogramming in myeloid cells to induce "trained immunity." Together, these sequelae of urate are thought to mediate most of the physiological effects of hyperuricemia and gout, illustrating this biologically active molecule is more than just an "end-product" of purine metabolism.
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Affiliation(s)
- Robert T Keenan
- Division of Rheumatology, Duke University School of Medicine, Durham 27710, NC, USA.
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14
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Abstract
Multiple interacting checkpoints are involved in the pathophysiology of gout. Hyperuricemia is the key risk factor for gout and is considered a prerequisite for monosodium urate (MSU) crystal formation. Urate underexcretion through renal and gut mechanisms is the major mechanism for hyperuricemia in most people. Multiple genetic, environmental, and metabolic factors are associated with serum urate and alter urate transport or synthesis. Urate supersaturation is the most important factor for MSU crystal formation, and other factors such as temperature, pH, and connective tissue components also play a role. The nucleotide-binding oligomerization domain leucine-rich repeats and pyrin domain-containing protein 3 inflammasome plays a pivotal role in the inflammatory response to MSU crystals, and interleukin 1β is the key cytokine mediating the inflammatory cascade. Variations in the regulatory mechanisms of this inflammatory response may affect an individual's susceptibility to developing gout. Tophus formation is the cardinal feature of advanced gout, and both MSU crystals and the inflammatory tissue component of the tophus contribute to the development of structural joint damage owing to gout. In this article, we review the pathophysiologic mechanisms of hyperuricemia, MSU crystal formation and the associated inflammatory response, tophus formation, and structural joint damage in gout.
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15
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Bernal JA, García-Campos J, Marco-LLedó J, Andrés M. Gouty Involvement of Foot and Ankle: Beyond Flares. REUMATOLOGIA CLINICA 2021; 17:106-112. [PMID: 32067922 DOI: 10.1016/j.reuma.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
The foot and ankle are common locations of deposition of monosodium urate (MSU) crystals, as indicated by the clinical manifestations presented by patients with gout, which are not limited to the acute inflammation of the big toe. We present a narrative literature review aimed to update the gout involvement of foot and ankle and how it affects the quality of life. Cumulative reports indicate that gout, even at the non-tophaceous stage, could cause pain, gait impairment and limit the mobility at lower limbs. These patients may present difficulties in some activities of daily living such as choosing footwear, thus leading to an impaired quality of life. Gout is a curable disease by dissolving MSU crystals but remains unclear how this could modify some of these foot and ankle manifestations, especially when structural damage has already occurred. Furthermore, a collaboration between rheumatologists and podiatrists seems helpful to understand, relieve these symptoms and improve the quality of life in gouty patients.
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Affiliation(s)
- José-Antonio Bernal
- Sección de Reumatología, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
| | - Jonatan García-Campos
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain
| | - Javier Marco-LLedó
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain
| | - Mariano Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
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16
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Zhang B, Xu H, Chen J, Zhu X, Xue Y, Yang Y, Ao J, Hua Y, Ji M. Highly specific and label-free histological identification of microcrystals in fresh human gout tissues with stimulated Raman scattering. Theranostics 2021; 11:3074-3088. [PMID: 33537075 PMCID: PMC7847673 DOI: 10.7150/thno.53755] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Gout is a common metabolic disease with growing burden, caused by monosodium urate (MSU) microcrystal deposition. In situ and chemical-specific histological identification of MSU is crucial in the diagnosis and management of gout, yet it remains inaccessible for current histological methods. Methods: Stimulated Raman scattering (SRS) microscopy was utilized to image MSU based on its fingerprint Raman spectra. We first tested SRS for the diagnosis capability of gout and the differentiation power from pseudogout with rat models of acute gout arthritis, calcium pyrophosphate deposition disease (CPDD) and comorbidity. Then, human synovial fluid and surgical specimens (n=120) were were imaged with SRS to obtain the histopathology of MSU and collagen fibers. Finally, quantitative SRS analysis was performed in gout tissue of different physiological phases (n=120) to correlate with traditional histopathology including H&E and immunohistochemistry staining. Results: We demonstrated that SRS is capable of early diagnosis of gout, rapid detection of MSU in synovial fluid and fresh unprocessed surgical tissues, and accurate differentiation of gout from pseudogout in various pathophysiological conditions. Furthermore, quantitative SRS analysis revealed the optical characteristics of MSU deposition at different pathophysiological stages, which were found to matched well with corresponding immunofluorescence histochemistry features. Conclusion: Our work demonstrated the potential of SRS microscopy for rapid intraoperative diagnosis of gout and may facilitate future fundamental researches of MSU-based diseases.
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17
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Gandikota G, Fakuda T, Finzel S. Computed tomography in rheumatology - From DECT to high-resolution peripheral quantitative CT. Best Pract Res Clin Rheumatol 2020; 34:101641. [PMID: 33281053 DOI: 10.1016/j.berh.2020.101641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this chapter, we discuss current updates and applications of Dual Energy Computed Tomography (DECT), iodine-DECT mapping, and high-resolution peripheral quantitative CT (HR-pQCT) in rheumatology. DECT provides a noninvasive diagnosis of gout and can help to differentiate gout from CPPD. Accuracy of DECT varies in various stages of gout. DECT needs specialized hardware, software, and skilled post-processing and interpretation. Sensitivity reduces significantly with deeper tissues such as hip and shoulder. Iodine map enables to delineate inflammatory lesions such as capsulitis and tenosynovitis by improving iodine contrast. Iodine quantification with an iodine map is a promising objective method to evaluate therapeutic effect of inflammatory arthritis. HR-pQCT allows for highly sensitive and specific measures of bone erosions and osteophytes in inflammatory joint diseases, documenting change over time, e.g. in cohorts undergoing immunosuppressive treatments. However, assessing the images requires trained readers, and (semi)-automated scripts to detect bone damage are still undergoing validation and further development.
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Affiliation(s)
- Girish Gandikota
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Takeshi Fakuda
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Chui CSK, Choi AKY, Lam MMY, Kwan TH, Li OC, Leng Y, Chow DLY. Volumetric reduction and dissolution prediction of monosodium urate crystal during urate-lowering therapy - a study using dual-energy computed tomography. Mod Rheumatol 2020; 31:875-884. [PMID: 32946311 DOI: 10.1080/14397595.2020.1825053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
METHODS Baseline and follow-up DECTs were performed under a standard ULT protocol. Monthly dissolution rates were calculated by simple and compound methods. Correlations with average SU were compared and analyzed. Best-fit regression model was identified. MSU dissolution times were plotted against SU at different endpoints. RESULTS In 29 tophaceous gout patients, MSU volume reduced from baseline 10.94 ± 10.59 cm3 to 2.87 ± 5.27 cm3 on follow-up (p = .00). Dissolution rate had a stronger correlation with SU if calculated by compound method (Pearson's correlation coefficient r= -0.77, p = .00) and was independent of baseline MSU load. The ensuing dissolution model was logarithmic and explained real-life scenarios. When SU > 0.43 mmol/l, dissolution time approached infinity. It improved to 10-19 months at SU = 0.24 mmol/l. When SU approximated zero (as with pegloticase), dissolution flattened and still took 4-8 months. CONCLUSION MSU dissolution is better described as a logarithmic function of SU, which explains, predicts, and facilitates understanding of the dissolution process.
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Affiliation(s)
- Charlotte Shek Kwan Chui
- Department of Orthopaedics and Traumatology, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Alexander Kai Yiu Choi
- Department of Orthopaedics and Traumatology, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Marianne Man Yan Lam
- Department of Orthopaedics and Traumatology, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Tze Hoi Kwan
- Department of Medicine and Geriatrics, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - On Chee Li
- Department of Radiology, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Yongmei Leng
- Department of Radiology, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Denise Long Yin Chow
- Department of Radiology, New Territories West Cluster, Hospital Authority, Hong Kong, China
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19
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Schwabl C, Taljanovic M, Widmann G, Teh J, Klauser AS. Ultrasonography and dual-energy computed tomography: impact for the detection of gouty deposits. Ultrasonography 2020; 40:197-206. [PMID: 33307617 PMCID: PMC7994744 DOI: 10.14366/usg.20063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/02/2020] [Indexed: 12/27/2022] Open
Abstract
Ultrasonography (US) and dual-energy computed tomography (DECT) are useful and sensitive diagnostic tools to identify monosodium urate deposits in joints and soft tissues. The purpose of this review is to overview the imaging findings obtained by US and DECT in patients with gout, to understand the strengths and weaknesses of each imaging modality, and to evaluate the added value of using both modalities in combination.
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Affiliation(s)
- Christoph Schwabl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Mihra Taljanovic
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ, USA
| | - Gerlig Widmann
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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20
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Pecherstorfer C, Simon D, Unbehend S, Ellmann H, Englbrecht M, Hartmann F, Figueiredo C, Hueber A, Haschka J, Kocijan R, Kleyer A, Schett G, Rech J, Bayat S. A Detailed Analysis of the Association between Urate Deposition and Erosions and Osteophytes in Gout. ACR Open Rheumatol 2020; 2:565-572. [PMID: 32955167 PMCID: PMC7571395 DOI: 10.1002/acr2.11172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize in detail the structural bone changes associated with the deposition of monosodium urate crystals in the first metatarsophalangeal (MTP1) joint in patients with tophaceous gout. METHODS Twenty patients with tophaceous gout and involvement of the MTP1 joint received both dual-energy computed tomography (DECT) of the feet for the detection of tophi and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the feet for the detection of bone erosions and osteophytes. Demographic and clinical data were collected. Tophi in DECT and erosions and osteophytes in HR-pQCT were overlayed to define their anatomical relation. In addition, the feet of 20 sex- and age-matched healthy controls were scanned to define the normal architecture of the MTP1 joint. RESULTS Patients with gout had an increased number and extent of bone erosions and osteophytes compared with their healthy counterparts (erosions: 5 [0-17] vs 1 [1-2], 45.32 mm3 [7.26-550.32] vs 0.82 mm3 [0.15-21.8]; osteophytes: 10.5 [0-26] vs 1 [0-10], 4.93 mm [0.77-7.19 mm] vs 0.93 mm [0.05-7.61 mm]; all P < 0.001). The median tophi volume detected by DECT (0.12 mm3 [0.01-2.53]) was highly associated with the total volume of erosions (r = 0.597, P = 0.005). CONCLUSION Gout patients show increased changes in their bone microarchitecture. The extent of uric acid deposition is positively correlated with the extent of bone loss at the MTP1 joint, highlighting the strong cohesion of inflammation and erosive changes.
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Affiliation(s)
- Caroline Pecherstorfer
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Unbehend
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hanna Ellmann
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Hartmann
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Camille Figueiredo
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel Hueber
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Judith Haschka
- St. Vincent Hospital, Vienna, Austria and Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rech
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Bayat
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
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21
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Stewart S, Aati O, Horne A, Doyle AJ, Dalbeth N. Radiographic damage scores predict grip strength in patients with tophaceous gout. Rheumatology (Oxford) 2020; 59:1440-1442. [PMID: 31794003 DOI: 10.1093/rheumatology/kez588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/31/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Anne Horne
- Department of Medicine, University of Auckland
| | - Anthony J Doyle
- Department of Radiology, Auckland District Health Board.,Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
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22
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Lee YH, Song GG. The Uric Acid and Gout have No Direct Causality With Osteoarthritis: A Mendelian Randomization Study. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.2.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Young Ho Lee
- Department of Rheumatology, Korea University College of Medicine, Seoul, Korea
| | - Gwan Gyu Song
- Department of Rheumatology, Korea University College of Medicine, Seoul, Korea
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Shi D, Chen JY, Wu HX, Zhou QJ, Chen HY, Lu YF, Yu RS. Relationship between urate within tophus and bone erosion according to the anatomic location of urate deposition in gout: A quantitative analysis using dual-energy CT volume measurements. Medicine (Baltimore) 2019; 98:e18431. [PMID: 31861011 PMCID: PMC6940130 DOI: 10.1097/md.0000000000018431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to measure the urate volume within tophus and bone erosion volume using dual-energy computed tomography in patients with tophaceous gout. Furthermore, our study aims to quantitatively analyze the relationship between monosodium urate (MSU) crystal deposition and bone erosion according to the anatomic location of urate deposition.Seventy-seven subjects with chronic gout were positively identified for the presence of urate deposition. Only 27 subjects identified for the presence of urate in contact with bone erosion were included in this study. The urate volumes and associated erosion volumes were measured. The relationships between urate within tophus and bone erosion were separately analyzed according to the anatomic location of urate deposition.Twenty-seven subjects were all male (100%) with a median (interquartile range, IQR) age of 52 (45-61) years. From all the subjects, 103 tophi depositions were identified in contact with bone erosion, including 58/103 tophi that contained an intraosseous component and 45/103 nonintraosseous tophi. Tophi containing intraosseous components were larger than nonintraosseous tophi (urate volume: median [IQR] 45.64 [4.79-250.89] mm vs 19.32 [6.97-46.71] mm, P = .035) and caused greater bone erosion (erosion volume: 249.03 [147.08-845.33] mm vs 69.07 [32.88-111.24] mm, P < .001). Almost all erosion volumes were larger than urate volumes in nonperiarticular tophi, in contrast to most erosion volumes, which were less than urate volumes in the tophi that contained a periarticular component (odds ratio, 95% confidence interval: 74.00, 14.70-372.60; P < .001). Urate volume and erosion volume demonstrated positive correlations in intraosseous tophi, intraosseous-intra-articular-periarticular tophi, and intraosseous-intra-articular tophi (rs = 0.761, rs = 0.695, rs = 0.629, respectively, P < .05).MSU crystal deposition shows a promoting effect on the development of bone erosions in varying degrees, associated with the location of MSU crystals deposited in the joints. The intraosseous tophi contribute the most to bone erosions, followed by intra-articular tophi, and periarticular tophi.
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Affiliation(s)
| | | | - Hua-Xiang Wu
- Department of Rheumatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Pascart T, Lioté F. Gout: state of the art after a decade of developments. Rheumatology (Oxford) 2019; 58:27-44. [PMID: 29547895 DOI: 10.1093/rheumatology/key002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 02/06/2023] Open
Abstract
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management. New imaging tools are available, including US with key features and dual-energy CT rendering it able to reveal deposits of urate crystals. These deposits are now included in new diagnostic and classification criteria. Overall, half of the patients with gout are readily treated with allopurinol, the recommended xanthine oxidase inhibitor (XOI), with prophylaxis for flares with low-dose daily colchicine. The main management issues are related to patient adherence, because gout patients have the lowest rate of medication possession ratio at 1 year, but they also include clinical inertia by physicians, meaning XOI dosage is not titrated according to regular serum uric acid level measurements for targeting serum uric acid levels for uncomplicated (6.0 mg/dl) and complicated gout, or the British Society for Rheumatology recommended target (5.0 mg/dl). Difficult-to-treat gout encompasses polyarticular flares, and mostly patients with comorbidities, renal or heart failure, leading to contraindications or side effects of standard-of-care drugs (colchicine, NSAIDs, oral steroids) for flares; and tophaceous and/or destructive arthropathies, leading to switching between XOIs (febuxostat) or to combining XOI and uricosurics.
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Affiliation(s)
- Tristan Pascart
- EA 4490, Lille University, Lille, France.,Service de Rhumatologie, Hôpital Saint-Philibert, Lomme, France
| | - Frédéric Lioté
- UFR de Médecine, University of Paris Diderot, USPC, France.,INSERM, UMR 1132 Bioscar (Centre Viggo Petersen), France.,Service de Rhumatologie (Centre Viggo Petersen), Pôle Appareil Locomoteur, Hôpital Lariboisière (AP-HP), Paris, France
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Neogi T, Krasnokutsky S, Pillinger MH. Urate and osteoarthritis: Evidence for a reciprocal relationship. Joint Bone Spine 2019; 86:576-582. [PMID: 30471419 PMCID: PMC6531371 DOI: 10.1016/j.jbspin.2018.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/17/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023]
Abstract
Hyperuricemia is a common condition, and in a subset of patients leads to gout, the most common inflammatory arthritis. Osteoarthritis is the most common form of arthritis overall, and gout and osteoarthritis frequently coexist in the same patient. However, the relationship between the two remains poorly defined. More particularly, the impact of osteoarthritis on the development of gout, and the impact of gout on the development of osteoarthritis, remain to be determined. Additionally, whether hyperuricemia mediates osteoarthritis in the absence of gout is uncertain. Here, we review the evidence linking gout and osteoarthritis, with a special focus on the role of hyperuricemia in the presence or absence of gout. Since disease modifying agents are currently available for hyperuricemia and gout but not for osteoarthritis, a contributory role for urate in the pathogenesis of osteoarthritis could have important clinical implications.
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Affiliation(s)
- Tuhina Neogi
- Sections of Clinical Epidemiology and Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Svetlana Krasnokutsky
- Rheumatology Section, Department of Medicine, New York Harbor Health Care System, New York Campus, US Department of Veterans Affairs, New York, NY, 10003, USA; Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine/NYU Langone Health, New York, NY, 10016, USA
| | - Michael H Pillinger
- Rheumatology Section, Department of Medicine, New York Harbor Health Care System, New York Campus, US Department of Veterans Affairs, New York, NY, 10003, USA; Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine/NYU Langone Health, New York, NY, 10016, USA; NYU Langone Orthopedic Hospital, 301 East 17th Street, Suite 1410, New York, NY 10003, USA.
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26
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Wang S, Pillinger MH, Krasnokutsky S, Barbour KE. The association between asymptomatic hyperuricemia and knee osteoarthritis: data from the third National Health and Nutrition Examination Survey. Osteoarthritis Cartilage 2019; 27:1301-1308. [PMID: 31158484 PMCID: PMC6702067 DOI: 10.1016/j.joca.2019.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/02/2019] [Accepted: 05/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In vitro and clinical studies suggest that urate may contribute to osteoarthritis (OA) risk. We tested the associations between hyperuricemia and knee OA, and examined the role of obesity, using a cross-sectional, nationally representative dataset. METHOD National Health and Nutrition Examination Survey (NHANES) III used a multistage, stratified probability cluster design to select USA civilians from 1988 to 1994. Using NHANES III we studied adults >60 years, with or without hyperuricemia (serum urate > 6.8 mg/dL), excluding individuals with gout (i.e., limiting to asymptomatic hyperuricemia (AH)). Radiographic knee OA (RKOA) was defined as Kellgren-Lawrence grade ≥ 2 in any knee, and symptomatic radiographic knee osteoarthritis (RKOA) (sRKOA) was defined as RKOA plus knee pain (most days for 6 weeks) in the same knee. RESULTS AH prevalence was 17.9% (confidence interval (CI) 15.3-20.5). RKOA prevalence was 37.7% overall (CI 35.0-40.3), and was 44.0% for AH vs 36.3% for normouricemic adults (p = 0.056). symptomatic radiographic knee osteoarthritis (sRKOA) was more prevalent in AH vs normouricemic adults (17.4% vs 10.9%, p = 0.046). In multivariate models adjusting for obesity, model-based associations between AH and knee OA were attenuated (for RKOA, prevalence ratio (PR) = 1.14, 95% CI 0.95, 1.36; for sRKOA, PR = 1.40, 95% CI 0.98, 2.01). In stratified multivariate analyses, AH was associated with sRKOA in adults without obesity (PR = 1.66, 95% CI 1.02, 2.71) but not adults with obesity (PR = 1.21, 95% CI 0.66, 2.23). CONCLUSIONS Among adults aged 60 or older, AH is associated with knee OA risk that is more apparent in adults without obesity.
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Affiliation(s)
- Shudan Wang
- Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY,Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY, USA,VA New York Harbor Health Care System, New York Campus, New York, NY, USA
| | - Michael H. Pillinger
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY, USA,VA New York Harbor Health Care System, New York Campus, New York, NY, USA
| | - Svetlana Krasnokutsky
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY, USA
| | - Kamil E. Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dalbeth N, Billington K, Doyle A, Frampton C, Tan P, Aati O, Allan J, Drake J, Horne A, Stamp LK. Effects of Allopurinol Dose Escalation on Bone Erosion and Urate Volume in Gout: A Dual-Energy Computed Tomography Imaging Study Within a Randomized, Controlled Trial. Arthritis Rheumatol 2019; 71:1739-1746. [PMID: 31081595 DOI: 10.1002/art.40929] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine whether allopurinol dose escalation to achieve serum urate (SU) target can influence bone erosion or monosodium urate (MSU) crystal deposition, as measured by dual-energy computed tomography (DECT) in patients with gout. METHODS We conducted an imaging study of a 2-year randomized clinical trial that compared immediate allopurinol dose escalation to SU target with conventional dosing for 1 year followed by dose escalation to target, in gout patients who were receiving allopurinol and who had an SU level of ≥0.36 mmoles/liter. DECT scans of feet and radiographs of hands and feet were obtained at baseline, year 1, and year 2 visits. DECT scans were scored for bone erosion and urate volume. RESULTS Paired imaging data were available for 87 patients (42 in the dose-escalation group and 45 in the control group). At year 2, the progression in the CT erosion score was higher in the control group than in the dose-escalation group (+7.8% versus +1.4%; P = 0.015). Changes in plain radiography erosion or narrowing scores did not differ between groups. Reductions in DECT urate volume were observed in both groups. At year 2, patients in the control group who had an SU level of <0.36 mmoles/liter and patients in the dose-escalation group had reduced DECT urate volume (-27.6 to -28.3%), whereas reduction in DECT urate volume was not observed in control group patients with an SU level of ≥0.36 mmoles/liter (+1.5%) (P = 0.023). CONCLUSION These findings provide evidence that long-term urate-lowering therapy using a treat-to-SU-target strategy can influence structural damage and reduce urate crystal deposition in gout.
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Affiliation(s)
| | | | - Anthony Doyle
- Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | | | - Paul Tan
- University of Auckland, Auckland, New Zealand
| | | | | | - Jill Drake
- University of Otago Christchurch, Christchurch, New Zealand
| | - Anne Horne
- University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
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Yokose C, Dalbeth N, Wei J, Nicolaou S, Simeone FJ, Baumgartner S, Fung M, Zhang Y, Choi HK. Radiologic evidence of symmetric and polyarticular monosodium urate crystal deposition in gout - A cluster pattern analysis of dual-energy CT. Semin Arthritis Rheum 2019; 50:54-58. [PMID: 31371194 DOI: 10.1016/j.semarthrit.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/13/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
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.
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Affiliation(s)
- Chio Yokose
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Jie Wei
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
| | - F Joseph Simeone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Maple Fung
- Formerly Ardea Biosciences Inc., San Diego, California, USA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Hyon K Choi
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA.
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Sun C, Qi X, Tian Y, Gao L, Jin H, Guo H. Risk factors for the formation of double-contour sign and tophi in gout. J Orthop Surg Res 2019; 14:239. [PMID: 31358044 PMCID: PMC6664526 DOI: 10.1186/s13018-019-1280-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to confirm the diagnostic accuracy of ultrasound (US) on gout and explore the potential risk factors for double-contour sign and tophi formation in gout patients. Methods The US analyses were performed on all knee, ankle, and first metatarsophalangeal (MTP 1) joints to reveal the type and location of lesions. While a questionnaire and blood biochemical index were used to explore the potential risk factors for double-contour sign and tophi in gout, the SPSS17.0 software was used for statistical analysis in the present study. Results Totally, 117 gout patients with 702 joints (38 lesions in knee joint, 93 lesions in ankle joint, and 112 lesions in MTP 1 joint) were enrolled in current analyses. Double-contour sign and joint effusion were the two most outstanding lesion manifestations in knee joints and ankle joints. Tophi and double-contour sign were the two most outstanding lesion manifestations in TMP 1 joints. Moreover, factors including uric acid (UA) level and the highest blood UA were potential risk factors of the double-contour sign, while age and history of US were potential risk factors for tophi. Conclusion US was effective on the joints of gout patients. There was US sensitivity for tophi and double-contour sign in MTP 1 joints. The double-contour sign was a potential specific manifestation in knee joints and ankle joints. Furthermore, UA and highest blood UA level were potential risk factors for double-contour sign, while age and US history were potential risk factors for tophi.
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Affiliation(s)
- Chao Sun
- Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Xuan Qi
- Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Yu Tian
- Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Lixia Gao
- Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Hongtao Jin
- Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Huifang Guo
- Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China.
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Lioté F, Mallen CD, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So AK, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2019; 79:31-38. [DOI: 10.1136/annrheumdis-2019-215315] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
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Chung MK, Kim IJ, Hyun H, Hwang JY, Lee J. Relationship between Urate Crystal Deposits Detected by Dual-energy Computed Tomography and Bone Erosions in Symptomatic Gout Patients without Clinically Apparent Tophi. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Min Kyung Chung
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - In Je Kim
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyeran Hyun
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Young Hwang
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Febuxostat in the treatment of gout patients with low serum uric acid level: 1-year finding of efficacy and safety study. Clin Rheumatol 2018; 37:3107-3113. [DOI: 10.1007/s10067-018-4283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/14/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
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Dalbeth N, Doyle AJ. Imaging tools to measure treatment response in gout. Rheumatology (Oxford) 2018; 57:i27-i34. [PMID: 29272513 DOI: 10.1093/rheumatology/kex445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 12/13/2022] Open
Abstract
Imaging tests are in clinical use for diagnosis, assessment of disease severity and as a marker of treatment response in people with gout. Various imaging tests have differing properties for assessing the three key disease domains in gout: urate deposition (including tophus burden), joint inflammation and structural joint damage. Dual-energy CT allows measurement of urate deposition and bone damage, and ultrasonography allows assessment of all three domains. Scoring systems have been described that allow radiological quantification of disease severity and these scoring systems may play a role in assessing the response to treatment in gout. This article reviews the properties of imaging tests, describes the available scoring systems for quantification of disease severity and discusses the challenges and controversies regarding the use of imaging tools to measure treatment response in gout.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony J Doyle
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
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Klein RW, Kabadi S, Cinfio FN, Bly CA, Taylor DC, Szymanski KA. Budget impact of adding lesinurad for second-line treatment of gout: a US health plan perspective. J Comp Eff Res 2018; 7:807-816. [PMID: 29792516 DOI: 10.2217/cer-2017-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: To estimate budget impact of adopting lesinurad as add-on to allopurinol for urate-lowering therapy in gout. Methods: A budget impact model was developed for a US payer perspective, using a Markov model to estimate costs, survival and discontinuation in a one-million-member health plan. The population included patients failing first-line gout therapy, followed for 5 years. Results: Incremental costs of adding lesinurad versus no lesinurad were US$241,907 and US$1,098,220 in first and fifth years, respectively. Cumulative 5-year incremental cost was US$3,633,440. Estimated incremental mean cost per treated patient with gout per year was US$112. The mean per-member per-month cost increased by US$0.06. Conclusion: Initiating lesinurad would result in an incremental per-member per-month cost of US$0.06 over 5 years.
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Affiliation(s)
- Robert W Klein
- Medical Decision Modeling, Inc., 3500 DePauw Blvd #1037, Indianapolis, IN 46268, USA
| | - Shaum Kabadi
- AstraZeneca LP, 101 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Frank N Cinfio
- Medical Decision Modeling, Inc., 201 N. Illinois #1175, Indianapolis, IN 46204, USA
| | - Christopher A Bly
- Medical Decision Modeling, Inc., 201 N. Illinois #1175, Indianapolis, IN 46204, USA
| | - Douglas Ca Taylor
- Ironwood Pharmaceuticals, 301 Binney Street, Cambridge, MA 02142, USA
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Panwar J, Sandhya P, Kandagaddala M, Nair A, Jeyaseelan V, Danda D. Utility of CT imaging in differentiating sacroiliitis associated with spondyloarthritis from gouty sacroiliitis: a retrospective study. Clin Rheumatol 2017; 37:779-788. [DOI: 10.1007/s10067-017-3865-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/12/2017] [Accepted: 10/01/2017] [Indexed: 11/28/2022]
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Alabsi H, Alreshoodi S, Low E, Sultan N, Murray N, Mallinson P, Munk PL, Ouellette HA. Advancements in Dual-Energy CT Applications for Musculoskeletal Imaging. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0249-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Yokose C, Chen M, Berhanu A, Pillinger MH, Krasnokutsky S. Gout and Osteoarthritis: Associations, Pathophysiology, and Therapeutic Implications. Curr Rheumatol Rep 2017; 18:65. [PMID: 27686950 DOI: 10.1007/s11926-016-0613-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Osteoarthritis (OA), the most common type of arthritis worldwide, is a degenerative disease of diarthrodial joints resulting in pain, reduced quality of life, and socioeconomic burden. Gout, the most common form of inflammatory arthritis, is a consequence of persistently elevated levels of urate and the formation of proinflammatory monosodium urate crystals in joints. Clinicians have long noted a predilection for both diseases to occur in the same joints. In this review, we provide an overview into research elucidating possible biochemical, mechanical, and immunological relationships between gout and OA. We additionally consider the potential implications of these relationships for OA treatment.
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Affiliation(s)
- Chio Yokose
- From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Meng Chen
- From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Adey Berhanu
- From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Michael H Pillinger
- From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Svetlana Krasnokutsky
- From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA. .,NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA.
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Bayat S, Aati O, Rech J, Sapsford M, Cavallaro A, Lell M, Araujo E, Petsch C, Stamp LK, Schett G, Manger B, Dalbeth N. Development of a Dual-Energy Computed Tomography Scoring System for Measurement of Urate Deposition in Gout. Arthritis Care Res (Hoboken) 2017; 68:769-75. [PMID: 26474153 DOI: 10.1002/acr.22754] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/01/2015] [Accepted: 09/29/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To develop a semiquantitative dual-energy computed tomography (DECT) scoring system for measurement of urate deposition in gout. METHODS Following a structured review of images, a semiquantitative DECT urate scoring method for foot/ankle scans was developed for testing. This method included 4 regions, each scored 0-3, with a maximum total DECT urate score of 12. DECT scans from 224 patients (182 with gout, 42 without gout) were scored by 2 independent readers. Automated urate volumes were also measured. Paired scans from 8 patients receiving pegloticase were analyzed, and a timing exercise was undertaken. The properties of the DECT urate score were analyzed according to the Outcome Measures in Rheumatology (OMERACT) filter. RESULTS The interreader intraclass correlation coefficient (95% confidence interval) for the DECT urate score was 0.98 (0.97-0.98). All scored regions contributed to the total DECT urate score. DECT urate scores and volumes were highly correlated (r = 0.91, P < 0.0001). Both DECT urate scores and volumes discriminated between gout and nongout control participants and between the tophaceous gout, nontophaceous gout, and control groups. Compared with urate volume, the DECT urate score had greater ability to discriminate between responders and nonresponders to pegloticase therapy (P < 0.001 for DECT urate score and P > 0.05 for volume). The mean ± SD time required for the DECT urate score was 121 ± 2 seconds and for urate volume was 240 ± 2 seconds (P = 2 × 10(-31) ). CONCLUSION We have developed a novel semiquantitative DECT scoring method for measurement of urate deposition in the feet/ankles. This method fulfills many aspects of the OMERACT filter.
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Affiliation(s)
- Sara Bayat
- University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Jürgen Rech
- University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Michael Lell
- University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | - Georg Schett
- University of Erlangen-Nuremberg, Erlangen, Germany
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Zhu J, Li A, Jia E, Zhou Y, Xu J, Chen S, Huang Y, Xiao X, Li J. Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study. Arthritis Res Ther 2017; 19:83. [PMID: 28464949 PMCID: PMC5414368 DOI: 10.1186/s13075-017-1286-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/24/2017] [Indexed: 12/27/2022] Open
Abstract
Background Previous 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. Methods One 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. Results At 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). Conclusions Large 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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Affiliation(s)
- Junqing Zhu
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Aiwu Li
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Ertao Jia
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Yi Zhou
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 511400, China
| | - Juan Xu
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Shixian Chen
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Yinger Huang
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Xiang Xiao
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Juan Li
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China. .,Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China.
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Chhana A, Doyle A, Sevao A, Amirapu S, Riordan P, Dray M, McGlashan S, Cornish J, Dalbeth N. Advanced imaging assessment of gout: comparison of dual-energy CT and MRI with anatomical pathology. Ann Rheum Dis 2017; 77:629-630. [PMID: 28283513 DOI: 10.1136/annrheumdis-2017-211343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Ashika Chhana
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony Doyle
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Amy Sevao
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Satya Amirapu
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Peter Riordan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Michael Dray
- Histology Department, Waikato Hospital, Hamilton, New Zealand
| | - Sue McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Bone & Joint Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
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Spaetgens B, van Durme C, Webers C, Tran-Duy A, Schoonbrood T, Boonen A. Construct Validity of Radiographs of the Feet to Assess Joint Damage in Patients with Gout. J Rheumatol 2016; 44:91-94. [PMID: 27909088 DOI: 10.3899/jrheum.160737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate construct validity of radiographic damage of the feet in gout. METHODS Radiographs of the feet were scored using the Sharp/van der Heijde method. Factors associated with damage were investigated by a negative binomial model, and contribution of damage to health by linear regressions. RESULTS Age, disease duration, serum uric acid, and tophi were associated with being erosive and erosion score. Tophi were associated with joint space narrowing. Erosions were associated (β 0.47, 95% CI 0.09-0.84) with physical function, but damage was not associated with overall physical health. CONCLUSION Our results support construct validity for radiographs of the feet when assessing joint damage in gout.
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Affiliation(s)
- Bart Spaetgens
- From the Department of Internal Medicine and Division of Rheumatology, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Département de Médecine Physique, Centre Hospitalier Chrétien, Liège, Belgium. .,B. Spaetgens, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University; C. van Durme, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Département de Médecine Physique, Centre Hospitalier Chrétien; C. Webers, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Tran-Duy, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; T. Schoonbrood, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University.
| | - Caroline van Durme
- From the Department of Internal Medicine and Division of Rheumatology, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Département de Médecine Physique, Centre Hospitalier Chrétien, Liège, Belgium.,B. Spaetgens, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University; C. van Durme, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Département de Médecine Physique, Centre Hospitalier Chrétien; C. Webers, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Tran-Duy, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; T. Schoonbrood, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University
| | - Casper Webers
- From the Department of Internal Medicine and Division of Rheumatology, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Département de Médecine Physique, Centre Hospitalier Chrétien, Liège, Belgium.,B. Spaetgens, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University; C. van Durme, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Département de Médecine Physique, Centre Hospitalier Chrétien; C. Webers, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Tran-Duy, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; T. Schoonbrood, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University
| | - An Tran-Duy
- From the Department of Internal Medicine and Division of Rheumatology, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Département de Médecine Physique, Centre Hospitalier Chrétien, Liège, Belgium.,B. Spaetgens, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University; C. van Durme, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Département de Médecine Physique, Centre Hospitalier Chrétien; C. Webers, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Tran-Duy, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; T. Schoonbrood, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University
| | - Thea Schoonbrood
- From the Department of Internal Medicine and Division of Rheumatology, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Département de Médecine Physique, Centre Hospitalier Chrétien, Liège, Belgium.,B. Spaetgens, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University; C. van Durme, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Département de Médecine Physique, Centre Hospitalier Chrétien; C. Webers, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Tran-Duy, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; T. Schoonbrood, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University
| | - Annelies Boonen
- From the Department of Internal Medicine and Division of Rheumatology, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Département de Médecine Physique, Centre Hospitalier Chrétien, Liège, Belgium.,B. Spaetgens, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University; C. van Durme, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Département de Médecine Physique, Centre Hospitalier Chrétien; C. Webers, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Tran-Duy, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; T. Schoonbrood, MD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and CAPHRI, Maastricht University
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Imaging of gout: New tools and biomarkers? Best Pract Res Clin Rheumatol 2016; 30:638-652. [PMID: 27931959 DOI: 10.1016/j.berh.2016.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 12/27/2022]
Abstract
While joint aspiration and crystal identification by polarizing microscopy remain the gold standard for diagnosing tophaceous gout, agreement among medical and ancillary health personnel examining synovial fluid using polarizing microscopy for the detection of monosodium urate (MSU) crystals appears to be poor. Imaging modalities, including conventional radiography (CR), ultrasonography (US), magnetic resonance imaging (MRI), and dual-energy computed tomography (DECT), have been found to provide information on the deposition of MSU crystals in tissues, and the consequences of such deposition. CR can demonstrate typical "punched out lesions" with marginal overhangs, but the sensitivity for erosion detection is better for DECT and US. US is inexpensive and can identify tophus deposition in and around joints, erosions, and tissue inflammation if power Doppler US is used. MRI can show tophi, bone marrow edema, and inflammation, but MRI findings of tophi may be nonspecific. DECT can identify and color-code tophaceous material, and provide an overview of the tophus burden of a joint area. Because of the lower number of available studies, the strength of evidence for the newer imaging can be improved through further research.
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Sapsford M, Gamble GD, Aati O, Knight J, Horne A, Doyle AJ, Dalbeth N. Relationship of bone erosion with the urate and soft tissue components of the tophus in gout: a dual energy computed tomography study. Rheumatology (Oxford) 2016; 56:129-133. [PMID: 27803304 DOI: 10.1093/rheumatology/kew383] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/15/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Imaging and pathology studies have established a close relationship between tophus and bone erosion in gout. The tophus is an organized structure consisting of urate crystals and chronic inflammatory tissue. The aim of this work was to examine the relationship between bone erosion and each component of the tophus. METHODS Plain radiographs and dual energy CT scans of the feet were prospectively obtained from 92 people with tophaceous gout. The 10 MTP joints were scored for erosion score, tophus urate and soft tissue volume. Data were analysed using generalized estimating equations and mediation analysis. RESULTS Tophus was visualized in 80.2% of all joints with radiographic (XR) erosion [odds ratio (OR) = 7.1 (95% CI: 4.8, 10.6)] and urate was visualized in 78.6% of all joints with XR erosion [OR = 6.6 (95% CI: 4.7, 9.3)]. In mediation analysis, tophus urate volume and soft tissue volume were directly associated with XR erosion score. About a third of the association of the tophus urate volume with XR erosion score was indirectly mediated through the strong association between tophus urate volume and tophus soft tissue volume. CONCLUSION Urate and soft tissue components of the tophus are strongly and independently associated with bone erosion in gout.
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Affiliation(s)
- Mark Sapsford
- Bone and Joint Research Group, Department of Medicine
| | | | - Opetaia Aati
- Bone and Joint Research Group, Department of Medicine
| | - Julie Knight
- Bone and Joint Research Group, Department of Medicine
| | - Anne Horne
- Bone and Joint Research Group, Department of Medicine
| | - Anthony J Doyle
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Towiwat P, Doyle AJ, Gamble GD, Tan P, Aati O, Horne A, Stamp LK, Dalbeth N. Urate crystal deposition and bone erosion in gout: 'inside-out' or 'outside-in'? A dual-energy computed tomography study. Arthritis Res Ther 2016; 18:208. [PMID: 27629724 PMCID: PMC5024428 DOI: 10.1186/s13075-016-1105-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/31/2016] [Indexed: 11/29/2022] Open
Abstract
Background It is currently unknown whether bone erosion in gout occurs through an ‘inside-out’ mechanism due to direct intra-osseous crystal deposition or through an ‘outside-in’ mechanism from the surface of bone. The aim of this study was to examine the mechanism (‘outside-in’ vs. ‘inside-out’) of monosodium urate (MSU) crystal deposition in bone erosion in gout. Specifically, we used three-dimensional dual-energy computed tomography (DECT) to analyse the positional relationship between bone and MSU crystal deposition in tophaceous gout, and to determine whether intra-osseous crystal deposition occurs in the absence of erosion. Methods One hundred forty-four participants with gout and at least one palpable tophus had a DECT scan of both feet. Two readers independently scored all metatarsal heads (1433 bones available for scoring). For bones in contact with urate, the bone was scored for whether urate was present within an erosion, on the surface of bone or within bone only (true intra-osseous deposit). Data were analysed using generalised estimating equations. Results Urate in contact with bone was present in 370 (54.3 %) of 681 joints with urate deposition. For those bones in contact with urate, deposition was present on the surface of bone in 143 (38.6 %) of 370 joints and within erosion in 227 (61.4 %) of 370. True intra-osseous urate deposition was not observed at any site (p < 0.0001). For all bones with apparent intra-osseous deposition in one plane, examination in other planes revealed urate deposition within an en face erosion. Conclusions In tophaceous gout, MSU crystal deposition is present within the joint, on the bone surface and within bone erosion, but it is not observed within bone in the absence of a cortical break. These data support the concept that MSU crystals deposit outside bone and contribute to bone erosion through an ‘outside-in’ mechanism.
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Affiliation(s)
- Patapong Towiwat
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.,Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Anthony J Doyle
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Gregory D Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Paul Tan
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Opetaia Aati
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Anne Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
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Breuer GS, Bogot N, Nesher G. Dual-energy computed tomography as a diagnostic tool for gout during intercritical periods. Int J Rheum Dis 2016; 19:1337-1341. [PMID: 27458073 DOI: 10.1111/1756-185x.12938] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study is to evaluate the diagnostic yield of dual-energy computed tomography (DECT) in detection of uric acid accumulation in joints or periarticular structures in patients suspected of having gout, in their intercritical period. METHODS Patients with a history of recurrent, short-lived mono- or oligo-arthralgia or arthritis, referred to the rheumatology clinic for diagnosis of their condition, were included in this retrospective evaluation. RESULTS DECT confirmed the diagnosis of gout in 30 of 50 patients (60%). A positive DECT was present in 12 of 16 cases (75%) with serum uric acid > 8.5 mg/dL, compared to seven of 13 cases (54%) and two of five cases (40%) with levels of 6.1-8.5 mg/dL and ≤ 6 mg/dL, respectively. The diagnostic impact of screening hands and feet were highest (78% and 56%, respectively). Follow-up data were available for 24 of the 30 patients with urate deposits identified by DECT. Twenty-one were treated with urate-lowering agents, all responded with lowering of serum uric acid and cessation of flares. Follow-up data were available for 16 of the 20 patients with no urate deposits identified by DECT. Gout was diagnosed in two of them by synovial fluid examination during subsequent flares. Both positive and negative predictive values of DECT for diagnosing gout in this patient population were 87%. Following DECT, treatment regimen was modified to gout-specific therapy in 52% of the patients. DISCUSSION The ability to make a definite diagnosis of gout by DECT imaging in a substantial number of asymptomatic patients in the intercritical period should help in treatment decision-making and improve patient adherence to long-term urate-lowering therapy.
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Affiliation(s)
- Gabriel S Breuer
- Rheumatology Unit, Department of Medicine, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Naama Bogot
- Department of Radiology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Gideon Nesher
- Rheumatology Unit, Department of Medicine, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
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Son CN, Kim TE, Park K, Hwang JH, Kim SK. Simplified Radiographic Damage Index for Affected Joints in Chronic Gouty Arthritis. J Korean Med Sci 2016; 31:435-42. [PMID: 26955246 PMCID: PMC4779870 DOI: 10.3346/jkms.2016.31.3.435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/19/2015] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to develop and validate a new radiographic damage scoring method (DAmagE index of GoUt; DAEGU) in chronic gout using plain radiography. Two independent observers scored foot x-rays from 15 patients with chronic gout according to the DAEGU method and the modified Sharp/van der Heijde (SvdH) method. The 10 metatarsophalangeal (MTP) and 2 interphalangeal (IP) joints of the first toes of both feet were scored to assess the degrees of erosion and joint space narrowing (JSN). The intraobserver and interobserver reliabilities were analyzed by calculating the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the DAEGU and SvdH methods was analyzed by calculating the Spearman's rho correlation coefficients and Kappa coefficients. The DAEGU method was found to be highly reproducible (0.945-0.987 for the intraobserver and 0.993-0.996 for the interobserver ICC values). The erosion, JSN, and total scores exhibited strong positive correlations between the DAEGU and SvdH methods and also within each method (r = 0.860-0.969, P < 0.001 for all parameters). The DAEGU and SvdH methods were in very good agreement as determined by Kappa coefficient analysis [0.732 (0.387-1.000) for erosion and 1.000 (1.000-1.000) for JSN]. In conclusion, this study revealed that DAEGU method was a reliable and feasible tool in the assessment of radiographic damage in chronic gout. The DAEGU method may provide a more easy assessment of structural damage in chronic gout in the real clinical practice.
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Affiliation(s)
- Chang-Nam Son
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Tae Eun Kim
- Department of Radiology, Fatima Hospital, Daegu, Korea
| | - Kyungmin Park
- Department of Radiology, Fatima Hospital, Daegu, Korea
| | - Jun Hyun Hwang
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Arthritis & Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Eason A, House ME, Vincent Z, Knight J, Tan P, Horne A, Gamble GD, Doyle AJ, Taylor WJ, Dalbeth N. Factors associated with change in radiographic damage scores in gout: a prospective observational study. Ann Rheum Dis 2016; 75:2075-2079. [PMID: 26912565 DOI: 10.1136/annrheumdis-2015-208937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/12/2016] [Accepted: 02/06/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIMS Radiographic damage is frequently observed in patients with longstanding gout. The aim of this prospective observational study was to determine factors associated with change in radiographic damage scores in gout. METHODS People with gout and disease duration <10 years were recruited into this prospective observational study. At the baseline visit, structured assessment was undertaken in 290 participants including detailed clinical examination and plain radiographs (XR) of the hands and feet. Participants were invited to attend a further study visit with repeat XR 3 years after the baseline visit. XR were scored for erosion and joint space narrowing according to the gout-modified Sharp/van der Heijde XR damage score. RESULTS Age, subcutaneous tophus count and tender joint count were independently associated with XR damage score at the baseline visit. Paired serial XR were available for 140 participants. In stepwise linear regression analysis, change in total damage score over 3 years was positively associated with change in subcutaneous tophus count and baseline XR damage score, and inversely associated with baseline subcutaneous tophus count (model R2=0.39, p<0.001). Change in subcutaneous tophus count contributed most to the change in erosion score (partial R2 change=0.31, p<0.001), and baseline XR damage score contributed most to the change in narrowing score (partial R2 change=0.31, p<0.001). CONCLUSIONS Development of new subcutaneous tophi and baseline radiographic damage are associated with progressive joint damage scores in people with gout. These data provide further evidence that the tophus plays a central role in bone erosion in gout.
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Affiliation(s)
- Alastair Eason
- Department of Radiology, Auckland District Health Board, Auckland, New Zealand
| | - Meaghan E House
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Zoe Vincent
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Julie Knight
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Paul Tan
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anne Horne
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gregory D Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony J Doyle
- Radiology with Anatomy, University of Auckland, Auckland, New Zealand
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Baer AN, Kurano T, Thakur UJ, Thawait GK, Fuld MK, Maynard JW, McAdams-DeMarco M, Fishman EK, Carrino JA. Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout. BMC Musculoskelet Disord 2016; 17:91. [PMID: 26891750 PMCID: PMC4758140 DOI: 10.1186/s12891-016-0943-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/12/2016] [Indexed: 12/27/2022] Open
Abstract
Background Dual-energy computed tomography (DECT) is a new diagnostic tool for gout, but its sensitivity has not been established. Our goal was to assess the sensitivity of DECT for the detection of monosodium urate (MSU) deposits in non-tophaceous and tophaceous gout, both at the level of the patient and that of the individual joint or lesion. Methods DECT was performed on 11 patients with crystal-proven non-tophaceous gout and 10 with tophaceous gout and included both the upper and lower extremities in 20/21 patients. DECT images were simultaneously acquired at 80 and 140 kV and then processed on a workstation with proprietary software using a two-material decomposition algorithm. MSU deposits were color coded as green by the software and fused onto grey-scale CT images. The number and location of these deposits was tallied independently by two DECT-trained radiologists blinded to the clinical characteristics of the patient. Sensitivity of DECT was defined as the proportion of patients with a confirmed diagnosis of gout which was correctly identified as such by the imaging technique. All patients provided informed consent to participate in this IRB-approved study. Results MSU deposits were detected by DECT in ≥1 joint area in 7/11 (64 %) patients with non-tophaceous gout, but were only detected in 3/12 (25 %) joints proven by aspiration to be affected with gout. Inclusion of the upper extremity joints in the scanning protocol did not improve sensitivity. All 10 patients with tophaceous gout had MSU deposits evident by DECT. The sensitivity of DECT for individual gouty erosions was assessed in 3 patients with extensive foot involvement. MSU deposits were detected by DECT within or immediately adjacent to 13/26 (50 %) erosions. Conclusions A DECT protocol that includes all lower extremity joints has moderate sensitivity in non-tophaceous and high sensitivity in tophaceous gout. However, DECT has lower sensitivity when restricted to individual crystal-proven gouty joints in non-tophaceous disease or individual erosive lesions in tophaceous gout. The detection of MSU deposits by DECT relates to their size and density and the detection parameters of the DECT scanner and adjustment of the latter might improve sensitivity.
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Affiliation(s)
- Alan N Baer
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4000, Mason Lord Center Tower, Baltimore, MD, 21224, USA.
| | - Tracie Kurano
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4000, Mason Lord Center Tower, Baltimore, MD, 21224, USA.
| | - Uma J Thakur
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Gaurav K Thawait
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Janet W Maynard
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4000, Mason Lord Center Tower, Baltimore, MD, 21224, USA.
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - John A Carrino
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Stewart S, Dalbeth N, Vandal AC, Rome K. The first metatarsophalangeal joint in gout: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016; 17:69. [PMID: 26864742 PMCID: PMC4750194 DOI: 10.1186/s12891-016-0919-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this review was to qualitatively synthesise studies that have investigated characteristics of the first metatarsophalangeal joint (1st MTP) in gout and to undertake a meta-analysis to estimate the average prevalence of acute 1st MTP arthritis across studies in people with gout. Methods Studies published in English were included if they involved participants who had a diagnosis of gout and presented original findings relating to the following outcome measures associated with the 1st MTP: epidemiology; clinical features; structural and functional characteristics; and microscopic and imaging features. Results Forty-five studies were included in the qualitative synthesis. 1st MTP pain was a prominent feature in people with gout. People with 1st MTP gout reported walking- and general-disability. Structural and functional characteristics of 1st MTP gout included hallux valgus, osteoarthritis, and restricted joint motion. Successful crystal aspiration ranged from 81 to 91 % and positive crystal identification via microscopy ranged from 83 to 93 % in patients with a history of 1st MTP gout. Imaging features were common at the 1st MTP including the double contour sign, tophi and erosions. Eleven studies involving 2,325 participants were included in the meta-analysis, providing an estimate of the average prevalence of acute 1st MTP arthritis across studies of 73 % (95 % prediction interval 40–92 %; range 48–97 %; I2 = 93 %). Conclusions 1st MTP acute arthritis is highly prevalent in people with gout and has a substantial impact on patient-reported pain and disability. Gout affects the structure and function of the 1st MTP. Microscopic and imaging studies have demonstrated crystal deposition and joint damage at the 1st MTP in people with gout.
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Affiliation(s)
- Sarah Stewart
- Faculty of Health and Environmental Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Alain C Vandal
- Department of Biostatistics & Epidemiology, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand. .,Health Intelligence & Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640, New Zealand.
| | - Keith Rome
- Faculty of Health and Environmental Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
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50
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The associations of serum uric acid level and hyperuricemia with knee osteoarthritis. Rheumatol Int 2016; 36:567-73. [PMID: 26743214 DOI: 10.1007/s00296-015-3418-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/23/2015] [Indexed: 12/31/2022]
Abstract
To examine the cross-sectional associations of the serum uric acid level and hyperuricemia (HU) with the radiographic features of osteoarthritis (OA), including osteophytes (OST) and joint space narrowing (JSN), a total of 4685 subjects were included in this study. Blood samples were drawn from all subjects. Serum uric acid and some other indexes were detected. OST and JSN were assessed for each subject according to the Osteoarthritis Research Society International (OARSI) atlas. A multivariable logistic analysis model was applied to test the target associations after adjusting a number of potential confounding factors. The prevalence of OST was increased in the highest tertile of uric acid compared to the lowest in female subjects (OR 1.46, 95 % CI 1.07-1.99, P for trend = 0.02). Meanwhile, a positive association between OST and HU was observed in female subjects (OR 1.43, 95 % CI 1.01-2.03, P = 0.05). However, serum uric acid and HU were not significantly associated with JSN in male subjects. The findings of this study indicated that the serum uric acid concentration and prevalence of HU are positively associated with OST of the knee in the female population. Level of evidence Cross-sectional study, Level III.
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