Journal List > J Rheum Dis > v.26(2) > 1122080

Chung, Kim, Hyun, Hwang, and Lee: Relationship between Urate Crystal Deposits Detected by Dual-energy Computed Tomography and Bone Erosions in Symptomatic Gout Patients without Clinically Apparent Tophi

Abstract

Objective

Dual-energy computed tomography (DECT) allows sensitive detection of monosodium urate (MSU) crystal deposits in gout. However, the role of MSU deposits on DECT during the disease process of gout is not clear. The aim of our study was to evaluate the relationship between joint damage and MSU deposits detected by DECT in symptomatic non-tophaceous gout.

Methods

DECT scans of 51 gout patients without clinically apparent tophi were assessed. Individual ankle and foot joints and Achilles tendon insertion sites were evaluated for the presence of MSU deposits and bone erosions. The total volume of MSU crystal on DECT was quantified using an automated software program. Clinical and laboratory data at the time of the DECT evaluation were obtained from medical record.

Results

MSU deposits were detected in 92.2% of the patients evaluated. Median number and total volume of MSU deposit per patient was 5.0 and 0.6 cm3, respectively. Bone erosion was found in 54.9% of patients. MSU deposits in the first (1st) metatarsophalangeal (MTP) joints were significantly associated with presence of bone erosions (odds ratio [OR] 3.77, 95% confidence interval [CI] 1.06∼13.38, p=0.040). Older age and frequent gout attack were associated with development of bone erosion in patients with MSU deposits (OR 1.12 and 2.57, 95% CI 1.04∼1.22 and 1.02∼6.50, p-value 0.004 and 0.047, respectively).

Conclusion

MSU deposits and erosions were frequently detected by DECT in symptomatic non-tophaceous gout patients, and MSU deposits in 1st MTP joints were associated with presence of bone erosions especially in patients with older age and frequent gout attack.

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Figure 1.
DECT of a 59-year old man with gout. Three-dimensional VRT image of both feet shows green MSU deposits adjacent right first MTP and left second MTP joints (A). Axial DECT image of both feet with small green microtophi (B). Coronal MPR DECT image presenting green microtophi around right first and left second MTP (C). Coronal MPR multi-de-tector CT image which shows erosion on right first MTP (arrow) (D). DECT: dual-energy computed tomography, VRT: volume rendering technique, MSU: monosodium urate, MTP: meta-tarsophalangeal, MPR: multi-planar reformation.
jrd-26-124f1.tif
Table 1.
Characteristics of patients (n=51)
Variable Value
Age (yr) 48.4±15.0
Male 47 (92.2)
Comorbidity 47 (92.2)
Diabetes mellitus 5 (9.8)
Hypertension 26 (51.0)
Hyperlipidemia 43 (84.3)
Previous CV event 8 (15.7)
Chronic kidney disease 8 (15.7)
Duration of gout (yr) 2.0 (0.0∼20.0)
Gout attack/year 2.0 (0.6∼12.0)
Alcohol intake >20 g/d 25 (50.0)
Serum urate (mg/dL) 8.10 (3.5∼15.4)
Symptomatic joints  
MTP Ankle 36 (70.6) 16 (31.4)
Mid-foot 8 (15.7)
Knee 2 (3.9)

Values are presented as mean±standard deviation, number (%), or median (range). CV: cardiovascular, MTP: metatarsophalangeal.

Table 2.
Characteristics of DECT findings (n=51)
Variable Value
Presence of MSU deposit 47 (92.2)
Number of MSU deposit/patient 5.0 (0∼17)
Total volume of MSU deposit/patients (cm3) 0.6 (0.05∼4.86)
Sites of MSU deposit
MTP joints 43 (84.3)
1st MTP 33 (64.7)
Ankle joints 33 (64.7)
Lisfranc joints 15 (29.4)
Transverse tarsal joints* 14 (27.5)
Achilles tendons 24 (47.1)
Presence of erosion 28 (54.9)
Mean number of erosion/patient 1.0 (0∼6)
Sites of erosion MTP joints 17 (33.3)
1st MTP 17 (33.3)
Ankle joints 12 (23.5)
Lisfranc joints 11 (21.6)
Transverse tarsal joints* 7 (13.7)

Values are presented as number (%) or median (range). DECT: dual-energy computed tomography, MSU: monosodium urate, MTP: metatarsophalangeal.

* Intertarsal, talonavicular, calcaneo-cuboidal.

Table 3.
Prevalence of erosions in joints with and without DECT MSU deposits (n=51)
Site With MSU crystal Without MSU crystal Odds ratio 95% confidence interval p-value
MTP joints 18/200 (9.0) 6/310 (1.9) 3.77 1.06∼13.38 0.040
1st MTP 18/53 (34.0) 6/49 (12.2) 3.77 1.06∼13.38 0.040
Ankle joints 8/56 (14.3) 6/46 (13.0) 1.06 0.37∼3.04 0.920
Lisfranc joints 2/21 (15.7) 14/81 (17.3) 0.50 0.10∼2.40 0.386
Transverse tarsal joints* 5/20 (25.0) 8/82 (9.8) 3.06 0.80∼11.59 0.100

Values are presented as number/total (%). Odds ratios and 95% confidence interval were estimated by the generalized estimating equation model. DECT: dual-energy computed tomography, MSU: monosodium urate, MTP: metatarsophalangeal.

* Intertarsal, talonavicular, calcaneo-cuboidal.

Table 4.
Multivariate analysis for development of bone erosion in patients with DECT MSU deposits (n=47)
    Univariate     Multivariate*  
Variable Crude OR 95% CI p-value Adjusted OR 95% CI p-value
Age 1.10 1.03∼1.17 0.003 1.12 1.04∼1.22 0.004
Male 0.00 0.00∼∞ 0.999      
Comorbidity
Diabetes mellitus 1.02 0.15∼6.77 0.984      
Hypertension 5.04 1.40∼18.14 0.013      
Hyperlipidemia 1.60 0.35∼7.38 0.547      
Previous CV 4.91 0.54∼44.60 0.158      
Chronic kidney disease 4.91 0.54∼4.60 0.158      
Duration of gout 1.14 0.95∼1.36 0.170      
Frequency of gout attack 1.84 0.93∼3.66 0.082 2.57 1.02∼6.50 0.047
Serum urate 0.81 0.52∼1.26 0.354      
Average volume of MSU deposit 4.05 0.29∼56.05 0.297      
Sites of MSU deposit
MTP 0.46 0.04∼4.82 0.519      
Ankle 0.41 0.11∼1.57 0.194      
Lisfranc 0.46 0.13∼1.60 0.221      
Transverse tarsal joint 0.87 0.24∼3.08 0.825      
Achilles 0.20 0.06∼0.71 0.013      

DECT: dual-energy computed tomography, MSU: monosodium urate, OR: odds ratio, CI: confidence interval, CV: cardiovascular, MTP: metatarsophalangeal.

* The presented factors were selected through multivariate logistic regression analysis using backward selection process among the statistically significant factors with p-value <0.1 in univariate analysis.

Total volume of MSU deposit/number of MSU deposit

Intertarsal, talonavicular, calcaneo-cuboidal.

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