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Park EH, O'Donnell T, Fritz J. Dual-Energy Computed Tomography Applications in Rheumatology. Radiol Clin North Am 2024; 62:849-863. [PMID: 39059976 DOI: 10.1016/j.rcl.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Dual-energy computed tomography (DECT) has emerged as a transformative tool in the past decade. Initially employed in gout within the field of rheumatology to distinguish and quantify monosodium urate crystals through its dual-material discrimination capability, DECT has since broadened its clinical applications. It now encompasses various rheumatic diseases, employing advanced techniques such as bone marrow edema assessment, iodine mapping, and collagen-specific imaging. This review article aims to examine the unique characteristics of DECT, discuss its strengths and limitations, illustrate its applications for accurately evaluating various rheumatic diseases in clinical practice, and propose future directions for DECT in rheumatology.
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Affiliation(s)
- Eun Hae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, USA; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Geonjiro 20, Deokjin-gu, Jeonju, Jeollabukdo 54907, Republic of Korea
| | - Thomas O'Donnell
- CT Research Collaborations Siemens Healthineers, Malvern PA, USA
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, USA.
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Rodriguez-Navarro C, Elert K, Ibañez-Velasco A, Monasterio-Guillot L, Andres M, Sivera F, Pascual E, Ruiz-Agudo E. Unraveling the pathological biomineralization of monosodium urate crystals in gout patients. Commun Biol 2024; 7:828. [PMID: 38972919 PMCID: PMC11228021 DOI: 10.1038/s42003-024-06534-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024] Open
Abstract
Crystallization of monosodium urate monohydrate (MSU) leads to painful gouty arthritis. Despite extensive research it is still unknown how this pathological biomineralization occurs, which hampers its prevention. Here we show how inflammatory MSU crystals form after a non-inflammatory amorphous precursor (AMSU) that nucleates heterogeneously on collagen fibrils from damaged articular cartilage of gout patients. This non-classical crystallization route imprints a nanogranular structure to biogenic acicular MSU crystals, which have smaller unit cell volume, lower microstrain, and higher crystallinity than synthetic MSU. These distinctive biosignatures are consistent with the template-promoted crystallization of biotic MSU crystals after AMSU at low supersaturation, and their slow growth over long periods of time (possibly years) in hyperuricemic gout patients. Our results help to better understand gout pathophysiology, underline the role of cartilage damage in promoting MSU crystallization, and suggest that there is a time-window to treat potential gouty patients before a critical amount of MSU has slowly formed as to trigger a gout flare.
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Grants
- PID2021.125305NB.I00 Ministry of Economy and Competitiveness | Agencia Estatal de Investigación (Spanish Agencia Estatal de Investigación)
- B-RNM-574-UGR20 Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía (Ministry of Economy, Innovation, Science and Employment, Government of Andalucia)
- RNM-179 Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía (Ministry of Economy, Innovation, Science and Employment, Government of Andalucia)
- UCE-PP2016-05 Universidad de Granada (University of Granada)
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Affiliation(s)
- Carlos Rodriguez-Navarro
- Department of Mineralogy and Petrology, University of Granada, Fuentenueva s/n, 18002, Granada, Spain.
| | - Kerstin Elert
- Department of Mineralogy and Petrology, University of Granada, Fuentenueva s/n, 18002, Granada, Spain
- Escuela de Estudios Arabes, Consejo Superior de Investigaciones Científicas (EEA-CSIC), C. Chapiz 22, 18010, Granada, Spain
| | - Aurelia Ibañez-Velasco
- Department of Mineralogy and Petrology, University of Granada, Fuentenueva s/n, 18002, Granada, Spain
| | - Luis Monasterio-Guillot
- Department of Mineralogy and Petrology, University of Granada, Fuentenueva s/n, 18002, Granada, Spain
| | - Mariano Andres
- Department of Clinical Medicine, Miguel Hernandez University, CN 332 s/n, 03550, Alicante, Spain
- Department of Rheumatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research, Av. Pintor Baeza s/n, 03010, Alicante, Spain
| | - Francisca Sivera
- Department of Clinical Medicine, Miguel Hernandez University, CN 332 s/n, 03550, Alicante, Spain
- Department of Rheumatology, Elda General University Hospital, Carretera Elda-Sax s/n, 03600, Elda, Spain
| | - Eliseo Pascual
- Department of Clinical Medicine, Miguel Hernandez University, CN 332 s/n, 03550, Alicante, Spain
- Department of Rheumatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research, Av. Pintor Baeza s/n, 03010, Alicante, Spain
| | - Encarnación Ruiz-Agudo
- Department of Mineralogy and Petrology, University of Granada, Fuentenueva s/n, 18002, Granada, Spain
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Brikman S, Serfaty L, Abuhasira R, Schlesinger N, Bieber A, Rappoport N. A machine learning-based prediction model for gout in hyperuricemics: a nationwide cohort study. Rheumatology (Oxford) 2024:keae273. [PMID: 38895877 DOI: 10.1093/rheumatology/keae273] [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: 10/21/2023] [Accepted: 05/03/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To develop a machine learning-based prediction model for identifying hyperuricemic participants at risk of developing gout. METHODS A retrospective nationwide Israeli cohort study used the Clalit Health Insurance database of 473 124 individuals to identify adults 18 years or older with at least two serum urate measurements exceeding 6.8 mg/dl between January 2007 and December 2022. Patients with a prior gout diagnosis or on gout medications were excluded. Patients' demographic characteristics, community and hospital diagnoses, routine medication prescriptions and laboratory results were used to train a risk prediction model. A machine learning model, XGBoost, was developed to predict the risk of gout. Feature selection methods were used to identify relevant variables. The model's performance was evaluated using the receiver operating characteristic area under the curve (ROC AUC) and precision-recall AUC. The primary outcome was the diagnosis of gout among hyperuricemic patients. RESULTS Among the 301 385 participants with hyperuricemia included in the analysis, 15 055 (5%) were diagnosed with gout. The XGBoost model had a ROC-AUC of 0.781 (95% CI 0.78-0.784) and precision-recall AUC of 0.208 (95% CI 0.195-0.22). The most significant variables associated with gout diagnosis were serum uric acid levels, age, hyperlipidemia, non-steroidal anti-inflammatory drugs and diuretic purchases. A compact model using only these five variables yielded a ROC-AUC of 0.714 (95% CI 0.706-0.723) and a negative predictive value (NPV) of 95%. CONCLUSIONS The findings of this cohort study suggest that a machine learning-based prediction model had relatively good performance and high NPV for identifying hyperuricemic participants at risk of developing gout.
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Affiliation(s)
- Shay Brikman
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Liel Serfaty
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Naomi Schlesinger
- Division of Rheumatology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Amir Bieber
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
| | - Nadav Rappoport
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Khayata K, Diekhoff T, Mews J, Schmolke S, Kotlyarov M. Virtual noncontrast images reveal gouty tophi in contrast-enhanced dual-energy CT: a phantom study. Eur Radiol Exp 2024; 8:69. [PMID: 38862843 PMCID: PMC11166610 DOI: 10.1186/s41747-024-00466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/08/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Dual-energy computed tomography (DECT) is useful for detecting gouty tophi. While iodinated contrast media (ICM) might enhance the detection of monosodium urate crystals (MSU), higher iodine concentrations hamper their detection. Calculating virtual noncontrast (VNC) images might improve the detection of enhancing tophi. The aim of this study was to evaluate MSU detection with VNC images from DECT acquisitions in phantoms, compared against the results with standard DECT reconstructions. METHODS A grid-like and a biophantom with 25 suspensions containing different concentrations of ICM (0 to 2%) and MSU (0 to 50%) were scanned with sequential single-source DECT using an ascending order of tube current time product at 80 kVp (16.5-220 mAs) and 135 kVp (2.75-19.25 mAs). VNC images were equivalently reconstructed at 80 and 135 kVp. Two-material decomposition analysis for MSU detection was applied for the VNC and conventional CT images. MSU detection and attenuation values were compared in both modalities. RESULTS For 0, 0.25, 0.5, 1, and 2% ICM, the average detection indices (DIs) for all MSU concentrations (35-50%) with VNC postprocessing were respectively 25.2, 36.6, 30.9, 38.9, and 45.8% for the grid phantom scans and 11.7, 9.4, 5.5, 24.0, and 25.0% for the porcine phantom scans. In the conventional CT image group, the average DIs were respectively 35.4, 54.3, 45.4, 1.0, and 0.0% for the grid phantom and 19.4, 17.9, 3.0, 0.0, and 0.0% for the porcine phantom scans. CONCLUSIONS VNC effectively reduces the suppression of information caused by high concentrations of ICM, thereby improving the detection of MSU. RELEVANCE STATEMENT Contrast-enhanced DECT alone may suffice for diagnosing gout without a native acquisition. KEY POINTS • Highly concentrated contrast media hinders monosodium urate crystal detection in CT imaging • Virtual noncontrast imaging redetects monosodium urate crystals in high-iodinated contrast media concentrations. • Contrast-enhanced DECT alone may suffice for diagnosing gout without a native acquisition.
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Affiliation(s)
- Karim Khayata
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Jürgen Mews
- Canon Medical Systems, Europe BV, Zoetermeer, The Netherlands
| | - Sydney Schmolke
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Maximilian Kotlyarov
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany
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Chianca V, Curti M, Robba T, Del Grande F. Neoplastic and Non-neoplastic Soft Tissue Lesions Around the Knee. Semin Musculoskelet Radiol 2024; 28:248-256. [PMID: 38768590 DOI: 10.1055/s-0044-1779652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Neoplastic and non-neoplastic soft tissue masses around the knee are often incidental findings. Most of these lesions are benign with typical imaging characteristics that allow a confident diagnosis. However, some of these incidental neoplastic masses are characterized by morbidity and potential mortality. This review highlights the typical aspects of these lesions, facilitating a correct diagnosis.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland
- Ospedale Evangelico Betania, Napoli, Italy
| | - Marco Curti
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland
| | - Tiziana Robba
- Dipartimento di Radiologia, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico, Torino, Italy
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Nazwar TA, Bal’afif F, Wardhana DW, Panjaitan C. Understanding spinal gout: A comprehensive study of 88 cases and their clinical implications. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:133-140. [PMID: 38957764 PMCID: PMC11216640 DOI: 10.4103/jcvjs.jcvjs_166_23] [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: 11/28/2023] [Accepted: 02/23/2024] [Indexed: 07/04/2024] Open
Abstract
Background Spinal gout, a rare and often underdiagnosed condition, significantly impacts patients' quality of life. Therefore, the aim of the research is to analyze cases of spinal gout, including clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, treatment choices, and outcomes from various cases of spinal gout. Methods The author conducted a systematic literature search in the PUBMED and Science Direct databases from 2013 to 2023. We included clinical case presentations of spinal cases in adults, published in English. The three researchers independently reviewed the title and abstract of each article, and any differences in opinions were resolved through consensus. The extracted data were subsequently analyzed descriptively. Results A total of 88 cases of spinal gout were obtained and studied. Out of the total reviewed cases of spinal gout, 89.77% of the subjects were male, with an average age of 51.9 years (age range 16-87 years). Common symptoms include back/neck pain (78.41%) and lower extremity weakness (37.50%). The lumbar spine is the most frequently affected region (62.50%), diagnosed primarily through magnetic resonance imaging (MRI) scans. Surgery, performed in 61.36% of cases, commonly involves decompressive laminectomy. Posttreatment, symptoms resolve in 87.50% of cases. Conclusion Cases of spinal gout present with a variety of symptoms, including back pain and weakness. Diagnosis typically involves an MRI examination and synovial fluid analysis for confirmation. Treatment varies and includes medication therapy and surgical interventions. A deeper understanding of these cases can assist healthcare practitioners in the management and diagnosis of spinal gout cases.
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Affiliation(s)
- Tommy Alfandy Nazwar
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
| | - Farhad Bal’afif
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
| | - Donny Wisnu Wardhana
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
| | - Christin Panjaitan
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
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Ji Z, Huang Y, Liang L, Lin P, Guo X, Huang Q, Huang Z, Chen S, Huang Z, Wang B, Huang L, Sun S, Deng W, Li T. Clinical characteristics and risk factors associated with bone erosion in patients with tophi. Adv Rheumatol 2024; 64:18. [PMID: 38438904 DOI: 10.1186/s42358-023-00336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/23/2023] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION If a large amount of urate crystals is deposited in a joint cavity for an extended period of time, bone erosion will occur and gradually cause skeletal muscle necrosis and joint deformity. The aim of this study was to describe the clinical characteristics and factors associated with bone erosion in gout patients with tophi. METHODS A total of 210 gout patients with tophi were enrolled and divided into a bone erosion group (n = 135) and a non-bone erosion group (n = 75). Digital radiography (DR) was performed to detect bone erosion in the elbow, wrist, knee, ankle joints, interphalangeal and metatarsophalangeal joints. The clinical characteristics were recorded and compared between the two groups. Multivariate logistic regression analysis was conducted to explore the factors associated with bone erosion. RESULTS Compared with the non-bone erosion group, the bone erosion group had an older age, longer disease duration of gout and tophi, higher level of serum creatinine (sCr), higher proportion of drinking history and ulceration, and a lower glomerular filtration rate (GFR). Univariate logistic regression analysis results showed that sex, age, body mass index (BMI), gout duration, tophi duration, GFR, white blood cell (WBC) count, sCr level, smoking history, drinking history, and presence of ulceration were associated with bone destruction. Multivariable logistic regression analysis results indicated that tophi duration, drinking history, ulceration and sCr were positively and independently related to bone erosion. CONCLUSIONS Tophi patients with bone erosion presented different clinical characteristics. Tophi duration, drinking history, ulceration and sCr were associated with bone erosion in gout patients with tophi.
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Affiliation(s)
- Zhuyi Ji
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510632, China
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Yukai Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Ling Liang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Paifeng Lin
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510632, China
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Xin Guo
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Qidang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Zhengping Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Shuyang Chen
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Zhixiang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Biao Wang
- Department of Cardiology, Liuzhou People' s Hospital, Affiliated of Guangxi Medical University, Liuzhou, 545006, China
| | - Lixin Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Shanmiao Sun
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Weiming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
| | - Tianwang Li
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510632, China.
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
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Jatuworapruk K. Toward a holistic tophus assessment in gout clinical trials: What lies beyond tophus count and size? Int J Rheum Dis 2024; 27:e15109. [PMID: 38450846 DOI: 10.1111/1756-185x.15109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Kanon Jatuworapruk
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Zhen-Li, De-Dai, Chen HK, Zhou XK. Asymptomatic Gouty Tophi in Thyroid Cartilage: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613231205540. [PMID: 37942800 DOI: 10.1177/01455613231205540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
Gouty tophi is a disease characterized by the long-term deposition of monosodium urate crystals in joints or cartilages. The most commonly affected site is the first metatarsophalangeal joint, and gouty tophi in the head and neck region are relatively rare. This article reports a case involving an elderly male with asymptomatic gouty tophi in the thyroid cartilage. The patient had a history of gout for over 10 years and presented with a painless thyroid mass that had been present for at least 3 years. He had not received systemic treatment. Preoperative contrast-enhanced cervical CT results indicated a high likelihood of gouty tophi. Postoperative pathology confirmed the mass to be consistent with gouty nodules. Following the procedure, the patient was treated symptomatically with non-busulfan tablets and colchicine. No recurrence was observed at the 1-year follow-up. This report highlights the need to consider gouty tophi in cases of prolonged gout history and abnormal imaging findings in the head and neck region. Appropriate management, including urate-lowering therapy and surgery, if necessary, can lead to optimal outcomes and prevent recurrences. Further research is warranted to enhance understanding and clinical management of this uncommon regional manifestation of gout.
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Affiliation(s)
- Zhen-Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - De-Dai
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Hui-Kuan Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Xin-Kai Zhou
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
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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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Cabău G, Gaal O, Badii M, Nica V, Mirea AM, Hotea I, Pamfil C, Popp RA, Netea MG, Rednic S, Crișan TO, Joosten LA. Hyperuricemia remodels the serum proteome toward a higher inflammatory state. iScience 2023; 26:107909. [PMID: 37810213 PMCID: PMC10550725 DOI: 10.1016/j.isci.2023.107909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/01/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Gout is an autoinflammatory disease triggered by a complex innate immune response to MSU crystals and inflammatory triggers. While hyperuricemia is an obligatory risk factor for the development of gout, the majority of individuals with hyperuricemia never develop gout but have an increased risk of developing cardiometabolic disorders. Current management of gout aims at MSU crystal dissolution by lowering serum urate. We apply a targeted proteomic analysis, using Olink inflammation panel, to a large group of individuals with gout, asymptomatic hyperuricemia, and normouricemic controls, and we show a urate-driven inflammatory signature. We add in vivo evidence of persistent immune activation linked to urate exposure and describe immune pathways involved in the pathogenesis of gout. Our results support a pro-inflammatory effect of asymptomatic hyperuricemia and pave the way for new research into targetable mechanisms in gout and cardiometabolic complications of asymptomatic hyperuricemia.
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Affiliation(s)
- Georgiana Cabău
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Orsolya Gaal
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Medeea Badii
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Valentin Nica
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Ioana Hotea
- Department of Rheumatology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - HINT-consortium
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
- Department of Rheumatology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Cristina Pamfil
- Department of Rheumatology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu A. Popp
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai G. Netea
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Simona Rednic
- Department of Rheumatology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tania O. Crișan
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Leo A.B. Joosten
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
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12
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Peng X, Li X, Xie B, Lai Y, Sosnik A, Boucetta H, Chen Z, He W. Gout therapeutics and drug delivery. J Control Release 2023; 362:728-754. [PMID: 37690697 DOI: 10.1016/j.jconrel.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
Gout is a common inflammatory arthritis caused by persistently elevated uric acid levels. With the improvement of people's living standards, the consumption of processed food and the widespread use of drugs that induce elevated uric acid, gout rates are increasing, seriously affecting the human quality of life, and becoming a burden to health systems worldwide. Since the pathological mechanism of gout has been elucidated, there are relatively effective drug treatments in clinical practice. However, due to (bio)pharmaceutical shortcomings of these drugs, such as poor chemical stability and limited ability to target the pathophysiological pathways, traditional drug treatment strategies show low efficacy and safety. In this scenario, drug delivery systems (DDS) design that overcome these drawbacks is urgently called for. In this review, we initially describe the pathological features, the therapeutic targets, and the drugs currently in clinical use and under investigation to treat gout. We also comprehensively summarize recent research efforts utilizing lipid, polymeric and inorganic carriers to develop advanced DDS for improved gout management and therapy.
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Affiliation(s)
- Xiuju Peng
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Xiaotong Li
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Bing Xie
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Yaoyao Lai
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Alejandro Sosnik
- Department of Materials Science and Engineering, Technion - Israel Institute of Technology, Technion City, Haifa 3200003, Israel
| | - Hamza Boucetta
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
| | - Wei He
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China; Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
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13
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Hao SH, Ye LY, Yang C. The landscape of pathophysiology guided therapeutic strategies for gout treatment. Expert Opin Pharmacother 2023; 24:1993-2003. [PMID: 38037803 DOI: 10.1080/14656566.2023.2291073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/30/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Gout is a common autoinflammatory disease caused by hyperuricemia with acute and/or chronic inflammation as well as tissue damage. Currently, urate-lowering therapy (ULT) and anti-inflammatory therapy are used as first-line strategies for gout treatment. However, traditional drugs for gout treatment exhibit some unexpected side effects and are not suitable for certain patients due to their comorbidity with other chronic disease. AREAS COVERED In this review, we described the pathophysiology of hyperuricemia and monosodium urate (MSU) crystal induced inflammatory response during gout development in depth and comprehensively summarized the advances in the investigation of promising ULT drugs as well as anti-inflammatory drugs that might be safer and more effective for gout treatment. EXPERT OPINION New drugs that are developed based on these molecular mechanisms exhibited great efficacy on reduction of disease burden both in vitro and in vivo, implying their potential for clinical application. Moreover, hyperthermia also showed regulation effect on MSU crystals formation and the signaling pathways involved in inflammation.
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Affiliation(s)
- Sai Heng Hao
- Department of Hematology of First Affiliated Hospital, and Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lin Yan Ye
- Department of Hematology of First Affiliated Hospital, and Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chang Yang
- Department of Hematology of First Affiliated Hospital, and Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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14
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Kotlyarov M, Mews J, Ulas ST, Ziegeler K, Hamm B, Diekhoff T. Influence of contrast medium on tophus detection using dual-energy CT: phantom study and clinical illustration. Eur Radiol Exp 2023; 7:43. [PMID: 37486463 PMCID: PMC10366067 DOI: 10.1186/s41747-023-00348-7] [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: 02/27/2023] [Accepted: 04/25/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND To investigate the influence of iodinated contrast medium (ICM) on detection of monosodium urate (MSU) with dual-energy computed tomography (DECT) in two types of phantoms and demonstrate an example patient for clinical illustration. METHODS Approval is by the institutional review board, and written informed consent was obtained. A grid-like and a biophantom with 25 suspensions containing different concentrations of ICM (0 to 2%) and MSU (0 to 50%) were prepared and scanned with sequential single-source DECT using established methodology. Ascending orders of tube currents were applied at 80 kVp (16.5 to 220.0 mAs) and 135 kVp (2.75 to 19.25 mAs). Volume and mass measurements were performed using clinical gout software (dual-energy decomposition analysis). Numbers of true-positive and false-positive MSU detections were recorded and compared for different ICM concentrations. We demonstrate a patient with gouty arthritis for clinical illustration. RESULTS Effects of ICM on MSU detection varied with the amount of iodine. Lower ICM concentrations (0.25 and 0.50%) improved detection of small uric acid concentrations of 35 to 45% in comparison to scans without ICM. However, high ICM concentrations (1 and 2%) almost completely precluded MSU detection for all MSU concentrations investigated. In a patient with gouty arthritis, tophi in the wrist were only detected after intravenous ICM administration. CONCLUSIONS Exploring multimodal DECT for arthritis imaging, enhancement of ICM influences tophus detection. It can help in visualizing previously undetected MSU depositions but, with too strong enhancement, also obscure tophi. RELEVANCE STATEMENT Use of iodinated contrast media in dual-energy CT might help in visualizing previously undetected uric acid depositions but, with too strong enhancement, obscure gouty tophi. KEY POINTS • Iodine significantly influences the uric acid crystal detection in systematic phantom studies. • Lower iodine concentrations improved detection of low and medium uric acid concentrations. • High concentrations of iodine hampered detection of all uric acid concentrations.
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Affiliation(s)
- Maximilian Kotlyarov
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany.
| | - Jürgen Mews
- Canon Medical Systems, Europe BV, Zoetermeer, Netherlands
| | - Sevtap Tugce Ulas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
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15
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Espinel DA, Martínez DC, Gómez MÁ, Duque DF, Torres PA, Rincón JV. Surgical Management of Tophaceous Gout in the Upper Limb. J Hand Surg Am 2023:S0363-5023(23)00209-5. [PMID: 37294239 DOI: 10.1016/j.jhsa.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Gouty tophi are a clinical manifestation of hyperuricemia in advanced stages. They can produce pain, functional limitation, and severe deformities. Patients with severe symptoms require short-term symptomatic solutions that standard medical management is not able to provide. The objective of this study was to present the results obtained with the surgical management of tophaceous gout in the upper limb, as well as present a detailed characterization of the disease in the upper limb. METHODS Databases of the hand surgery service of a quaternary care hospital were reviewed to identify patients aged >18 years old undergoing tophi resection in the upper limbs between 2014 and 2020. Medical history records were reviewed retrospectively, and the relevant data were extracted to establish demographic profile, clinical presentation, anatomic distribution, postoperative outcomes, and additional procedures required. RESULTS The most frequent symptom was pain (83%), followed by limited range of motion (56%), deformity (50%), and daily living/occupational activity limitation (28%). The main indications for surgical management were the presence of deformity, pain, and/or limited range of motion. The most frequently affected anatomic sites were the metacarpophalangeal joints, followed by the elbows, proximal interphalangeal joints, and proximal phalanges. The postoperative complication rate was 28%. The most common complications were operative site infections and wound dehiscence. Decreased pain was associated with surgical resection. Additional procedures, such as extensor tenorrhaphy and local flaps, were required in 47.2% of patients. CONCLUSION Surgical resection of tophi can decrease pain. Although surgery is associated with a high rate of complications, most are minor. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Daniel A Espinel
- Plastic Surgery Unit, National University of Colombia, Bogotá, Colombia; Faculty of Medicine, National University of Colombia, Bogotá, Colombia.
| | - Diana C Martínez
- Plastic Surgery Unit, National University of Colombia, Bogotá, Colombia; Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - María Á Gómez
- Plastic Surgery Unit, National University of Colombia, Bogotá, Colombia; Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - David F Duque
- Plastic Surgery Unit, National University of Colombia, Bogotá, Colombia; Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - Paula A Torres
- Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - Juliana V Rincón
- Department of Clinical Epidemiology, National University of Colombia, Bogotá, Colombia
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16
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Elsaid K, Merriman TR, Rossitto LA, Liu-Bryan R, Karsh J, Phipps-Green A, Jay GD, Elsayed S, Qadri M, Miner M, Cadzow M, Dambruoso TJ, Schmidt TA, Dalbeth N, Chhana A, Höglund J, Ghassemian M, Campeau A, Maltez N, Karlsson NG, Gonzalez DJ, Terkeltaub R. Amplification of Inflammation by Lubricin Deficiency Implicated in Incident, Erosive Gout Independent of Hyperuricemia. Arthritis Rheumatol 2023; 75:794-805. [PMID: 36457235 PMCID: PMC10191887 DOI: 10.1002/art.42413] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE In gout, hyperuricemia promotes urate crystal deposition, which stimulates the NLRP3 inflammasome and interleukin-1β (IL-1β)-mediated arthritis. Incident gout without background hyperuricemia is rarely reported. To identify hyperuricemia-independent mechanisms driving gout incidence and progression, we characterized erosive urate crystalline inflammatory arthritis in a young female patient with normouricemia diagnosed as having sufficient and weighted classification criteria for gout according to the American College of Rheumatology (ACR)/EULAR gout classification criteria (the proband). METHODS We conducted whole-genome sequencing, quantitative proteomics, whole-blood RNA-sequencing analysis using serum samples from the proband. We used a mouse model of IL-1β-induced knee synovitis to characterize proband candidate genes, biomarkers, and pathogenic mechanisms of gout. RESULTS Lubricin level was attenuated in human proband serum and associated with elevated acute-phase reactants and inflammatory whole-blood transcripts and transcriptional pathways. The proband had predicted damaging gene variants of NLRP3 and of inter-α trypsin inhibitor heavy chain 3, an inhibitor of lubricin-degrading cathepsin G. Changes in the proband's serum protein interactome network supported enhanced lubricin degradation, with cathepsin G activity increased relative to its inhibitors, SERPINB6 and thrombospondin 1. Activation of Toll-like receptor 2 (TLR-2) suppressed levels of lubricin mRNA and lubricin release in cultured human synovial fibroblasts (P < 0.01). Lubricin blunted urate crystal precipitation and IL-1β induction of xanthine oxidase and urate in cultured macrophages (P < 0.001). In lubricin-deficient mice, injection of IL-1β in knees increased xanthine oxidase-positive synovial resident M1 macrophages (P < 0.05). CONCLUSION Our findings linked normouricemic erosive gout to attenuated lubricin, with impaired control of cathepsin G activity, compounded by deleterious NLRP3 variants. Lubricin suppressed monosodium urate crystallization and blunted IL-1β-induced increases in xanthine oxidase and urate in macrophages. The collective activities of articular lubricin that could limit incident and erosive gouty arthritis independently of hyperuricemia are subject to disruption by inflammation, activated cathepsin G, and synovial fibroblast TLR-2 signaling.
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Affiliation(s)
- Khaled Elsaid
- Chapman University School of Pharmacy, Irvine, California
| | - Tony R Merriman
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, and Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Leigh-Ana Rossitto
- Department of Pharmacology, School of Medicine, and Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, California
| | - Ru Liu-Bryan
- VA San Diego Healthcare System, San Diego, and Department of Medicine, UC San Diego, La Jolla, California
| | - Jacob Karsh
- The Ottawa Hospital, Division of Rheumatology, University of Ottawa, Canada
| | | | - Gregory D Jay
- Department of Emergency Medicine, Alpert School of Medicine, and Division of Biomedical Engineering, School of Engineering, Brown University, Rhode, Island
| | - Sandy Elsayed
- Chapman University School of Pharmacy, Irvine, California
| | | | - Marin Miner
- VA San Diego Healthcare System, San Diego, California
| | - Murray Cadzow
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Talia J Dambruoso
- Division of Biomedical Engineering, School of Engineering, Brown University, Rhode, Island
| | - Tannin A Schmidt
- Biomedical Engineering Department, School of Dental Medicine, UConn Health, Farmington, Connecticut
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ashika Chhana
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Jennifer Höglund
- Department of Medical Biochemistry, Institute for Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Majid Ghassemian
- Biomolecular and Proteomics Mass Spectrometry Facility, Department of Chemistry/Biochemistry, UC San Diego
| | - Anaamika Campeau
- Department of Pharmacology, School of Medicine, and Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, California
| | - Nancy Maltez
- The Ottawa Hospital, Division of Rheumatology, University of Ottawa, Canada
| | - Niclas G Karlsson
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway, and Department of Medical Biochemistry, Institute for Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - David J Gonzalez
- Department of Pharmacology, School of Medicine, and Skaggs School of Pharmacy and Pharmaceutical Sciences, Collaborative Center for Multiplexed Proteomics, Program for Integrative Omics and Data Science in Disease Prevention and Therapeutics, UC San Diego, La Jolla, California
| | - Robert Terkeltaub
- VA San Diego Healthcare System and Department of Medicine, UC San Diego
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17
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Shioazaki T, Kimura T, Saito M, Kubota M. Three Cases of Gouty Tophus in the Foot Treated by Resection. Cureus 2023; 15:e37144. [PMID: 37153285 PMCID: PMC10160552 DOI: 10.7759/cureus.37144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
Abstract
We encountered three cases of gouty tophus in the foot that required resection. All patients were male and aged 44-68 years at the time of surgery. The lesions were located on the great toe, second toe, and lateral malleolus and were causing ulceration and destruction of the joints. One patient had normal uric acid levels, and another patient had hyperuricemia but no history of attacks and no significant inflammatory symptoms around the gouty tophus, which was attributed to the physical containment of uric acid crystals by the gouty tophus. Given that the crystals were adherent to the surrounding fibrous tissue and cartilage surface, we resected them as far as possible to reduce the total amount of crystals and treated the remaining crystals with uric acid-lowering therapy. There were no complications at the time of surgery. The swelling and bone destruction subsided with continued medical treatment, resulting in significant improvement in quality of life. Patients with gouty tophus should be treated aggressively with medication and monitored to prevent severe joint destruction and ulceration. Excision of the nodule should be considered in cases of exacerbation.
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18
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Tao H, Mo Y, Liu W, Wang H. A review on gout: Looking back and looking ahead. Int Immunopharmacol 2023; 117:109977. [PMID: 37012869 DOI: 10.1016/j.intimp.2023.109977] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Gout is a metabolic disease caused by the deposition of monosodium urate (MSU) crystals inside joints, which leads to inflammation and tissue damage. Increased concentration of serum urate is an essential step in the development of gout. Serum urate is regulated by urate transporters in the kidney and intestine, especially GLUT9 (SLC2A9), URAT1 (SLC22A12) and ABCG. Activation of NLRP3 inflammasome bodies and subsequent release of IL-1β by monosodium urate crystals induce the crescendo of acute gouty arthritis, while neutrophil extracellular traps (NETs) are considered to drive the self-resolving of gout within a few days. If untreated, acute gout may eventually develop into chronic tophaceous gout characterized by tophi, chronic gouty synovitis, and structural joint damage, leading the crushing burden of treatment. Although the research on the pathological mechanism of gout has been gradually deepened in recent years, many clinical manifestations of gout are still unable to be fully elucidated. Here, we reviewed the molecular pathological mechanism behind various clinical manifestations of gout, with a view to making contributions to further understanding and treatment.
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Sanghavi N, Korem S, Dey S, Wasserman A, Ash J. Dual-Energy Computed Tomography (DECT) Resolves the Diagnostic Dilemma in an Atypically Presenting Case of Gout. Cureus 2023; 15:e38247. [PMID: 37252479 PMCID: PMC10225115 DOI: 10.7759/cureus.38247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Gout is a common inflammatory arthropathy that presents as acute monoarthritis, most commonly of the first metatarsophalangeal (MTP) joint. Chronic polyarticular involvement may lead to confusion with other inflammatory arthropathies, including rheumatoid arthritis (RA). A thorough history, physical examination, synovial fluid analysis, and imaging are keys to establishing a correct diagnosis. Although a synovial fluid analysis remains the gold standard, the affected joints may be difficult to access by arthrocentesis. In cases where a large monosodium urate (MSU) crystal deposition is in the soft tissues - the ligaments, bursae, and tendons, it becomes a clinical impossibility. In such cases, dual-energy computed tomography (DECT) can assist in differentiating gout from other inflammatory arthropathies, including RA. Additionally, DECT can perform quantitative analysis of tophaceous deposits and, therefore, assess response to treatment.
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Affiliation(s)
- Nirali Sanghavi
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | | | - Subo Dey
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Amy Wasserman
- Rheumatology, Westchester Medical Center, Valhalla, USA
| | - Julia Ash
- Rheumatology, Westchester Medical Center, Valhalla, USA
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20
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Fareez F, Moodley J, Popovic S, Lu JQ. Rheumatoid nodules: a narrative review of histopathological progression and diagnostic consideration. Clin Rheumatol 2023:10.1007/s10067-023-06589-6. [PMID: 36991243 DOI: 10.1007/s10067-023-06589-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
Rheumatoid nodules (RNs) are the most common extra-articular manifestation of rheumatoid arthritis and are also seen in patients with other autoimmune and inflammatory diseases. The development of RNs includes histopathological stages of acute unspecified inflammation, granulomatous inflammation with no or minimal necrosis, necrobiotic granulomas typically with central fibrinoid necrosis surrounded by palisading epithelioid macrophages and other cells, and likely an advanced stage of "ghost" lesions containing cystic or calcifying/calcified areas. In this article, we review RN pathogenesis, histopathological features in different stages, diagnostically related clinical manifestations, as well as diagnosis and differential diagnosis of RNs with an in-depth discussion about challenges in distinguishing RNs from their mimics. While the pathogenesis of RN formation remains elusive, it is hypothesized that some RNs with dystrophic calcification may be in transition and may be in coexistence or collision with another lesion in patients with RA or other soft tissue diseases and comorbidities. The diagnosis of typical or mature RNs in usual locations can be readily made by clinical findings often with classic RN histopathology, but in many cases, particularly with atypical or immature RNs and/or unusual locations, the clinical and histopathological diagnosis can be challenging requiring extensive examination of the lesional tissue with histological and immunohistochemical markers to identify unusual RNs in the clinical context or other lesions that may be coexisting with classic RNs. Proper diagnosis of RNs is critical for appropriate treatment of patients with RA or other autoimmune and inflammatory diseases.
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Affiliation(s)
- Faiha Fareez
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jinesa Moodley
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, 237 Barton Street, Hamilton, Ontario, L8L 2X2, Canada.
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21
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Verstappen G, Michel O, Halewyck S, Topsakal V, Pössneck A. Infected nasal gout tophus: A case report. Clin Case Rep 2022; 10:e6695. [PMCID: PMC9743314 DOI: 10.1002/ccr3.6695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Gout is a common form of inflammatory arthritis, characterized by the deposition of monosodium urate crystals. If chronically present and not adequately treated by serum urate reducers, gout tophi can develop at various locations. Here, we report the first infected gout tophus at the septal cartilage and nasal tip.
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Affiliation(s)
- Gill Verstappen
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
| | - Olaf Michel
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
| | - Stijn Halewyck
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
| | - Antje Pössneck
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
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22
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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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23
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Therapeutic Utility and Adverse Effects of Biologic Disease-Modifying Anti-Rheumatic Drugs in Inflammatory Arthritis. Int J Mol Sci 2022; 23:ijms232213913. [PMID: 36430392 PMCID: PMC9692587 DOI: 10.3390/ijms232213913] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Targeting specific pathologic pro-inflammatory cytokines or related molecules leads to excellent therapeutic effects in inflammatory arthritis, including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Most of these agents, known as biologic disease-modifying anti-rheumatic drugs (bDMARDs), are produced in live cell lines and are usually monoclonal antibodies. Several types of monoclonal antibodies target different pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin (IL)-17A, IL-6, and IL-23/12. Some bDMARDs, such as rituximab and abatacept, target specific cell-surface molecules to control the inflammatory response. The therapeutic effects of these bDMARDs differ in different forms of inflammatory arthritis and are associated with different adverse events. In this article, we summarize the therapeutic utility and adverse effects of bDMARDs and suggest future research directions for developing bDMARDs.
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Tang SJ, Giri S, Pahlavan N, Han SH, Santos ER, Espinal G, Aishworiya R, Schneider A, Hessl D, Rivera SM, Hagerman RJ. Tophaceous gout of the nose in a male
FMR1
premutation carrier. Clin Case Rep 2022; 10:e6586. [PMCID: PMC9701845 DOI: 10.1002/ccr3.6586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Si Jie Tang
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
| | | | - Nima Pahlavan
- Kaiser Permanente North Valley Roseville California USA
| | | | - Ellery R. Santos
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
| | - Glenda Espinal
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
| | - Ramkumar Aishworiya
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
- Khoo Teck Puat‐National University Children's Medical Institute National University Health System Singapore Singapore
- Department of Pediatrics, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
| | - David Hessl
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
- Department of Psychiatry and Behavioral Sciences University of California Davis School of Medicine Sacramento California USA
| | - Susan M. Rivera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
- University of Maryland College Park Maryland USA
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute University of California Davis Davis California USA
- Department of Pediatrics University of California Davis School of Medicine Sacramento California USA
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Neutel K, Mes S, Merkus P. Patient With Hearing Loss and a Middle Ear Mass. JAMA Otolaryngol Head Neck Surg 2022; 148:2795922. [PMID: 36107408 DOI: 10.1001/jamaoto.2022.2589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
A 65-year-old patient with a history of myocardial infarction, sleep apnea, Meniere disease, and congenital cataract presented with left-sided hearing loss during the past 6 months without evident cause. What is your diagnosis?
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Affiliation(s)
- Kjell Neutel
- University Medical Center Utrecht, Heidelberglaan , Utrecht, Netherlands
| | - Steven Mes
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Paul Merkus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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26
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Kötter I. [Granulomatous diseases-Granuloma, the (un)known species? : A brief introduction]. Z Rheumatol 2022; 81:531-534. [PMID: 36094588 DOI: 10.1007/s00393-022-01251-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Ina Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander Str. 26, Bad Bramstedt, Deutschland. .,Sektion für Rheumatologie und Entzündliche Systemerkrankungen, UKE Hamburg, Martinistr. 52, Hamburg, Deutschland.
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27
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Abreu Casas D, López-Piloto OR, Rodríguez de la Paz NJ, Plasencia-Leonardo JM, Íñiguez-Avendaño D, Gutierrez JV. Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report. Cureus 2022; 14:e27101. [PMID: 36000115 PMCID: PMC9391668 DOI: 10.7759/cureus.27101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
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28
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Jia E, Zhu H, Geng H, Zhong L, Qiu X, Xie J, Xiao Y, Jiang Y, Xiao M, Zhang Y, Wei J, Tang D, Zhang J. The Inhibition of Osteoblast Viability by Monosodium Urate Crystal-Stimulated Neutrophil-Derived Exosomes. Front Immunol 2022; 13:809586. [PMID: 35655781 PMCID: PMC9152014 DOI: 10.3389/fimmu.2022.809586] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/22/2022] [Indexed: 12/27/2022] Open
Abstract
Background and Objective Bone erosion is common in patients with gout. The role of neutrophil-derived exosomes in gouty bone erosion remains elusive. This study aimed to investigate the functions of the neutrophil-derived exosomes in the development of bone erosion in gout. Methods Neutrophil-derived exosomes were collected and assessed by transmission electron microscopy and nanoparticle tracking analysis. Cell counting kit-8 assay was applied to evaluate cell viability, and cell apoptosis was assessed by flow cytometry. In addition, quantitative Real-time PCR and Western blotting were used to determine the expression levels of alkaline phosphatase (ALP), osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL). Neutrophil-derived exosomes were tagged with PKH67. The miRNA expression profiles of exosomes and human fetal osteoblasts (hFOB) were compared using high-throughput sequencing. Functional miRNAs transfected into hFOB after co-incubation with exosomes were selected and validated by preliminary qPCR. Results Neutrophil-derived exosomes were stimulated by monosodium urate (MSU). The exosomes could inhibit the viability of the hFOB, and the expression levels of ALP and OPG were down-regulated, while the expression level of RANKL was up-regulated. However, there was no significant difference in the viability of osteoclasts and the expression of nuclear factor of activated T cells 1. Exosomes were observed in the cytoplasm under a confocal microscopy, confirming that exosomes could be taken up by hFOB. In total, 2590 miRNAs were found, of which 47 miRNAs were differentially expressed. Among the delivered miRNAs, miR-1246 exhibited the highest level of differential expression. The viability of hFOB was reduced by miR-1246 mimics and increased by miR-1246 inhibitors. There was no significant difference in hFOB apoptosis rate between the miR-1246 mimic and miR-1246 inhibitor group. MiR-1246 overexpression decreased the expression levels of ALP and OPG, whereas increasing the expression level of RANKL. In contrast, miR-1246 inhibitor increased the expression levels of ALP and OPG, while decreasing the expression level of RANKL. Neutrophil-derived exosomes stimulated by MSU could increase the expression of miR-1246. Conclusion Neutrophil-derived exosomes stimulated by MSU could inhibit the viability of osteoblasts.
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Affiliation(s)
- Ertao Jia
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Haiqiong Zhu
- Shenzhen Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Shenzhen, China
| | - Hongling Geng
- The Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li Zhong
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xia Qiu
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jingjing Xie
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yuya Xiao
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yubao Jiang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Min Xiao
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yanying Zhang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiaxin Wei
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Dabin Tang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jianyong Zhang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
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29
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Song Y, Kang ZW, Liu Y. Multiple gouty tophi in the head and neck with normal serum uric acid: A case report and review of literatures. World J Clin Cases 2022; 10:1373-1380. [PMID: 35211572 PMCID: PMC8855169 DOI: 10.12998/wjcc.v10.i4.1373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/30/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gouty tophus is rarely reported in the head and neck areas. To the best of our knowledge, this is the first report on multiple gouty tophi in the head and neck with normal serum uric acid (SUA) levels.
CASE SUMMARY We report a case of multiple gouty tophi in the nasal dorsal and auricle regions with normal SUA levels. The patient was admitted to the hospital with a chief complaint of recurrent nasal swelling and pain for 3 years, which was aggravated for 3 d. The patient’s SUA level had been regularly reviewed in the outpatient department and had been successfully controlled for several years. Resection of the nasal masses was performed. Cartilage from the right ear cavity was used to repair the nasal defects. The pathological report confirmed a nasal gouty tophus. No recurrence or deformity was found after a 1 year follow-up.
CONCLUSION Normal SUA cannot completely negate the diagnosis of gouty tophus, especially in some rare regions.
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Affiliation(s)
- Yang Song
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Zi-Wei Kang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Yan Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
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30
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Renouf C. Late presentation of severe gouty tophi affecting both hands. BMJ Case Rep 2022; 15:e246818. [PMID: 35039366 PMCID: PMC8768497 DOI: 10.1136/bcr-2021-246818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Caitlin Renouf
- Renal Dept, South Tees Hospitals NHS Foundation Trust, Middlesbrough, Cleveland, UK
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31
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Gouty Tophus in the Scrotum: An Unusual Extra-Articular Manifestation of Gout. Ochsner J 2022; 21:413-415. [PMID: 34984058 PMCID: PMC8675627 DOI: 10.31486/toj.20.0143] [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] [Indexed: 11/29/2022] Open
Abstract
Background: Gout is a chronic disorder caused by the deposition of monosodium urate crystals in soft tissues. Tophi are granulomatous inflammatory responses to the deposited crystals and manifest as subcutaneous nodules, typically in the first metatarsophalangeal joint but also in the olecranon bursa, Achilles tendon, ears, and finger pulps. Case Report: A 56-year-old male presented to an outpatient clinic with an 8-month history of an expanding scrotal lesion. The patient had no significant family history but had a history of high blood pressure and gout, diagnosed at age 24 years, without current treatment. Excisional biopsy from the ulcerated area of the scrotum was performed for confirmatory diagnosis, and pathology reported gouty tophus. Conclusion: To our knowledge, this case is the first report of a scrotal manifestation of gouty tophus and the second of genital involvement. Awareness of the possibility of genital manifestations of this disease is important because although gouty tophi are rare, they can present in patients with long-term uncontrolled gout.
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Mikuls TR, Soto Q, Petro A, Helget L, Roul P, Sayles H, Cope B, Neogi T, LaMoreaux B, O’Dell JR, England BR. Comparison of Rates of Lower Extremity Amputation in Patients With and Without Gout in the US Department of Veterans Affairs Health System. JAMA Netw Open 2022; 5:e2142347. [PMID: 34989795 PMCID: PMC8739736 DOI: 10.1001/jamanetworkopen.2021.42347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
Importance Cardiometabolic and other risk factors could render patients with gout more likely to undergo lower extremity amputation (LEA). Objective To examine the rate of and factors associated with LEA in patients with gout. Design, Setting, and Participants In this matched cohort study using national administrative data, multivariable Cox proportional hazards regression models were used to examine the associations of gout with LEA. In analyses limited to patients with gout, attributes of serum urate control and treatment with urate-lowering therapy were examined as factors associated with LEA. This study included patients who used US Department of Veterans Affairs services from January 1, 2000, to July 31, 2015. Patients with gout were identified using diagnostic codes and matched with up to 10 controls by age, sex, and year of benefit enrollment. Data analysis was performed from January 26, 2021, to September 3, 2021. Exposures Gout classification served as the primary independent variable of interest. In analyses limited to patients with gout, factors associated with serum urate control and urate-lowering therapy were examined. Main Outcomes and Measures Overall LEA, as well as toe, transmetatarsal, below-the-knee, and above-the-knee amputation. Results This cohort study included 5 924 918 patients, 556 521 with gout (mean [SD] age, 67 [12] years; 550 963 (99.0%) male; 88 853 [16.0%] Black non-Hispanic; 16 981 [4.3%] Hispanic/Latinx; 345 818 [62.1%] White non-Hispanic; 80 929 [14.5%] with race and ethnicity data missing; and 23 940 [4.3%] classified as other) and 5 368 397 without gout (mean [SD] age, 67 [12] years; 5 314 344 [99.0%] male; 558 464 [10.4%] Black non-Hispanic; 204 291 [3.0%] Hispanic/Latinx; 3 188 504 [59.4%] White non-Hispanic; 1 257 739 [23.4%)] with race and ethnicity data missing; and 159 399 [3.0%] classified as other). Compared with patients without gout, patients with gout were more likely to undergo amputation, an increased rate that remained after adjustment (adjusted hazard ratio, 1.20; 95% CI, 1.16-1.24) and was highest for below-the-knee amputation (adjusted hazard ratio, 1.59; 95% CI, 1.39-1.81). In those with gout, poor serum urate control (mean >7 mg/dL during the preceding year) was associated with a 25% to 37% increase in the rate of amputation. In contrast, treatment with urate-lowering therapy was not associated with the LEA rate. Conclusions and Relevance In this matched cohort study, patients with gout were more likely to undergo LEA. This increase was independent of other comorbidities that have been associated with amputation, including diabetes and peripheral vascular disease. Serum urate control was independently associated with the LEA rate, suggesting the possibility that lower extremity amputation may be preventable in some patients.
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Affiliation(s)
- Ted R. Mikuls
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Quint Soto
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Alison Petro
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Lindsay Helget
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Punyasha Roul
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Harlan Sayles
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Brendan Cope
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - James R. O’Dell
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Bryant R. England
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
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Abstract
INTRODUCTION Gout is the most common form of inflammatory arthritis affecting millions of people around the world. Painful flares and tophaceous deposits can be debilitating, reducing quality of life among those affected and putting strain on health care systems. AREAS COVERED This review provides an overview of the treatment of gout for flare pain management and lowering serum urate. Firstline agents are discussed with emphasis on emerging evidence. Novel therapies are also covered. EXPERT OPINION Lifestyle modifications form a part of gout prevention. Regarding gout flare pharmacotherapy NSAIDs, colchicine and glucocorticoids are first line agents. The IL-1β antagonists also are highly effective for arresting flares but their cost-effectiveness render them as salvage therapies. Allopurinol is an agent of first choice for urate lowering therapy (ULT). In South East Asian and Black populations screening for HLA*B58:01 mutation is a cost-effective approach to decrease the occurrence of the rare but potentially very serious allopurinol hypersensitivity syndrome (AHS.). Febuxostat is another efficacious urate lowering therapy but it has received U.S. FDA black box warning for cardiovascular safety and careful consideration is warranted before its initiation in patients with high cardiovascular risk. Novel uricosurics are a class for continued drug development; verinurad and arhalofenate are agents with future promise. For patients with recalcitrant gout, pegloticase is another effective option in the rheumatologist's armamentarium. Its immunogenicity significantly threatens the achievement of sustained urate lowering responses. Abrogating pegloticase's immunogenicity with immunomodulatory co-therapy may lend to sustained efficacy.
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Affiliation(s)
- K E G Blake
- Clinical Fellow, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, 1720 2nd Ave South, FOT 839. Birmingham, AL 35294-3408
| | - Jordan L Saag
- Medical Student, University of Central Florida College of Medicine, 6850 Lake Nona Blvd. Orlando, FL 32827
| | - Kenneth G Saag
- Director, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, 1720 2nd Ave South, FOT 839. Birmingham, AL 35294-3408
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Wang Q, Bao H, Guo LH, Jin FS, Li XL, Yin HH, Yue WW, Zhu AQ, Wang LF, Sun LP, Xu HX. Quantitative assessment of crystal dissolution in gout during urate-lowering therapy with computer-aided MicroPure imaging: a cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1444. [PMID: 34733996 PMCID: PMC8506744 DOI: 10.21037/atm-21-4059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
Background To evaluate whether MicroPure imaging, an ultrasound (US) image-processing technique with computer-aided analysis, can quantitatively detect crystal dissolution during urate-lowering therapy (ULT) in gout. Methods This was a prospective study of gout patients requiring ULT. The first metatarsophalangeal joints were examined using US and MicroPure before and after 3 months of ULT. Elementary lesions of gout, including the double contour sign (DCS), aggregates, tophi, erosion, and other US features were recorded at baseline and 3 months. MicroPure imaging features were automatically calculated by a self-developed software. Patients were divided into goal-achieved and goal-not-achieved groups according to their urate levels at 3 months. The US and MicroPure imaging features of the two groups were analyzed at baseline and 3 months. Results A total of 55 consecutive patients were enrolled (25: goal-achieved group; 30: goal-not-achieved group). US findings demonstrated that the power Doppler signal grade decreased at 3 months, regardless of the group (both P<0.05). From baseline to 3 months, tophi size and the DCS reduced in the goal-achieved group (both P<0.05), while the US aggregate features showed no difference (P=0.250). However, on the MicroPure imaging, the number and density of aggregates at 3 months decreased in the goal-achieved group (both P<0.05). There were no significant changes at 3 months in any of the MicroPure imaging features in the goal-not-achieved group (all P>0.05). Conclusions In comparison with B-mode US, computer-aided MicroPure imaging can sensitively and quantitatively detect aggregate dissolution during effective ULT after only 3 months of treatment.
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Affiliation(s)
- Qiao Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui Bao
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng-Shan Jin
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hao-Hao Yin
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - An-Qi Zhu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Fan Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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The role of dual energy computed tomography in the differentiation of acute gout flares and acute calcium pyrophosphate crystal arthritis. Clin Rheumatol 2021; 41:223-233. [PMID: 34626261 PMCID: PMC8724058 DOI: 10.1007/s10067-021-05949-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/27/2022]
Abstract
Objectives To analyse the diagnostic impact of dual energy computed tomography (DECT) in acute gout flares and acute calcium pyrophosphate (CPP) crystal arthritis when compared to the gold standard of arthrocentesis with compensated polarised light microscopy. Microscopy results were also compared to musculoskeletal ultrasound (MUS), conventional radiographs, and the suspected clinical diagnosis (SCD). Methods Thirty-six patients with a suspected gout flare (n = 24) or acute CPP crystal arthritis (n = 11, n = 1 suffered from neither) who received a DECT and underwent arthrocentesis were included. Two independent readers assessed DECT images for signs of monosodium urate crystals or calcium pyrophosphate deposition. Results Sensitivity of DECT for gout was 63% (95% CI 0.41–0.81) with a specificity of 92% (0.41–0.81) while sensitivity and specificity for acute CPP arthritis were 55% (0.23–0.83) and 92% (0.74–0.99), respectively. MUS had the highest sensitivity of all imaging modalities with 92% (0.73–0.99) and a specificity of 83% (0.52–0.98) for gout, while sensitivity and specificity for acute CPP crystal arthritis were 91% (0.59–1.00) and 92% (0.74–0.99), respectively. Conclusion DECT is an adequate non-invasive diagnostic tool for acute gout flares but might have a lower sensitivity than described by previous studies. Both MUS and SCD had higher sensitivities than DECT for acute gout flares and acute CPP crystal arthritis. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-021-05949-4.
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Murdoch R, Jones P, Greenwell J, Dalbeth N. Quality of care in people requiring hospital admission for gout in Aotearoa New Zealand: a nationwide analysis. Intern Med J 2021; 52:2136-2142. [PMID: 34339089 DOI: 10.1111/imj.15470] [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: 04/28/2021] [Revised: 06/28/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Abstract
AIMS To understand national trends in hospital admission for a primary diagnosis of gout in Aotearoa New Zealand over the past 10 years and the quality of care for gout received by these patients before and after the admission. METHODS Data from the Aotearoa New Zealand National Collections from 1 January 2007 to 31 December 2019 were analysed to determine rates of hospital admission for a primary diagnosis of gout. Admission data including cost-weight analysis, as well as quality of care data including gout-specific medication dispensing in the year prior and year after admission. RESULTS There were 13,721 admissions with a primary diagnosis of gout over the analysis period, with an average cost per admission in 2019 of NZD 4,301. The rate of admission per 100,000 population was highest in Pacific peoples followed by MĀori. Although dispensing of any allopurinol increased in the year after admission, rates of regular allopurinol dispensing remained low; 38.1% for admissions in 2018. Patients who were younger (especially 20-44 years), not enrolled in a primary health organisation before admission, and female had lower rate of regular allopurinol after admission. CONCLUSION In this nationwide study, rates of admission for gout were highest in Pacific peoples and in MĀori. Rates of regular allopurinol dispensing was low even after admission for a primary diagnosis of gout. These findings highlight the need for improvements in gout management in Aotearoa New Zealand, including in post-discharge planning from secondary care inpatient services. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rachel Murdoch
- Clinical Research Fellow, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Rheumatologist and Clinical Lead - System Improvement, Ministry of Health, New Zealand
| | - James Greenwell
- Principal Advisor, Ministry of Health, New Zealand, and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Rheumatologist and Professor of Medicine, Department of Medicine, University of Auckland, Auckland, New Zealand
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Galozzi P, Bindoli S, Luisetto R, Sfriso P, Ramonda R, Scanu A, Oliviero F. Regulation of crystal induced inflammation: current understandings and clinical implications. Expert Rev Clin Immunol 2021; 17:773-787. [PMID: 34053376 DOI: 10.1080/1744666x.2021.1937129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Accumulation of abnormal crystals in the body, derived from endogenous or exogenous materials can drive a wide spectrum of inflammatory disease states. It is well established that intra-articular deposition of monosodium urate (MSU) and calcium pyrophoshate (CPP) crystals contributes to joint destruction through pro-inflammatory processes.Areas covered: This review will focus on current understanding and recent novelty about the mechanisms and the clinical implications of the inflammation induced by MSU and CPP crystals.Expert opinion: Advances in molecular biology reveal that at the base of the inflammatory cascade, stimulated by MSU or CPP crystals, there are many complex cellular mechanisms mainly involving the NLRP3 inflammasome, the hallmark of autoinflammatory syndromes. The extensive studies carried out through in vitro and in vivo models along with a better clinical definition of the disease has led to an optimized use of existing drugs and the introduction of novel therapeutic strategies. In particular, the identification of IL-1 as the most important target in gout and pseudogout has made it possible to expand the pharmacological indications of anti-IL-1 biological drugs, opening new therapeutic perspectives for patients.
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Affiliation(s)
- Paola Galozzi
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Sara Bindoli
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Roberto Luisetto
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padova, Padova, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
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Marty-Ané A, Norberciak L, Andrès M, Houvenagel E, Ducoulombier V, Legrand J, Budzik JF, Pascart T. Crystal deposition measured with dual-energy computed tomography: association with mortality and cardiovascular risks in gout. Rheumatology (Oxford) 2021; 60:4855-4860. [DOI: 10.1093/rheumatology/keaa920] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Abstract
Objectives
To determine whether the volume of monosodium urate (MSU) crystal deposition measured with dual-energy CT (DECT) is predictive of short-term mortality and development of cardiovascular comorbidities and diabetes mellitus.
Methods
Patients with a diagnosis of gout having had baseline DECT scans of their knees and feet to measure the volume of MSU crystal deposition were included to undergo a follow-up visit. Risk factors for mortality and a composite variable (onset of any cardio-metabolic event) were examined using multivariable Cox models.
Results
A total of 128 patients aged 66.1 (14.0) years with gout durations of 11.4 (10.4) years were included; most were naïve of urate lowering therapy (61.7%), with a follow-up visit at 24 (12, 36) months. Baseline serum urate (SU) level was 7.44 (2.29) mg/dl and DECT volume of MSU crystals was 0.2 (0, 0.9) cm3. A total of 14 patients died during follow-up, 6/14 from a cardiovascular cause, and 17 patients presented a new cardio-metabolic comorbidity. Factors associated with mortality risk were baseline DECT volume of MSU crystals [hazard ratio (HR) 1.02, 95% CI: 1.002, 1.03] and baseline SU level (HR 1.04, 95% CI: 1.003, 1.06). DECT volume of MSU crystals was the only factor associated with the onset of cardio-metabolic comorbidities with a HR of 1.014 (95% CI: 1.001, 1.03).
Conclusions
Volume of MSU crystals measured with DECT is a biomarker for the risk of developing new cardio-metabolic diseases and for all-cause mortality.
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Affiliation(s)
- Anne Marty-Ané
- Rheumatology Department, Lille Catholic Hospitals, Lille Catholic University
| | - Laurène Norberciak
- Research Department, Biostatistics, Lille Catholic Hospitals, Lille, France
| | - Mariano Andrès
- Rheumatology Department, Alicante General University Hospital-ISABIAL
- Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain
| | - Eric Houvenagel
- Rheumatology Department, Lille Catholic Hospitals, Lille Catholic University
| | | | - Julie Legrand
- Department of Musculoskeletal Imaging, Lille Catholic Hospitals, Lille Catholic University
| | - Jean-François Budzik
- Department of Musculoskeletal Imaging, Lille Catholic Hospitals, Lille Catholic University
- MABLab, ULR 4490, Lille University, Lille, France
| | - Tristan Pascart
- Rheumatology Department, Lille Catholic Hospitals, Lille Catholic University
- MABLab, ULR 4490, Lille University, Lille, France
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Bang HI, Choi IH, Park R. Bone Marrow Gouty Tophi With Plasma Cell Myeloma. Ann Lab Med 2021; 40:414-416. [PMID: 32311855 PMCID: PMC7169628 DOI: 10.3343/alm.2020.40.5.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/23/2019] [Accepted: 03/20/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hae In Bang
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - In Ho Choi
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Rojin Park
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
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40
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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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Richards E, Watts E, McClelland L. A rare case of nasal gout. BMJ Case Rep 2020; 13:13/10/e234788. [PMID: 33127723 DOI: 10.1136/bcr-2020-234788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gout is an increasingly common metabolic disorder worldwide. Classical presentation is with acute attacks of arthritis affecting the first metatarsophalangeal joint. With disease progression, tophi may also appear. We present an unusual case of nasal gout in a 55-year-old man who was referred to the Ear, Nose and Throat department with irregularity over the nasal bones and episodic pain. We discuss the work up, diagnosis and management of this case and review the limited literature on this topic.
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Affiliation(s)
- Emma Richards
- ENT, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Watts
- ENT, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lisha McClelland
- ENT, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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42
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Multiarticular Deforming and Erosive Tophaceous Gout With Severe Comorbidities. J Clin Rheumatol 2020; 26:e269-e271. [PMID: 31192860 PMCID: PMC7523572 DOI: 10.1097/rhu.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Not All Green Is Tophi: The Importance of Optimizing Minimum Attenuation and Using a Tin Filter to Minimize Clumpy Artifacts on Foot and Ankle Dual-Energy CT. AJR Am J Roentgenol 2020; 214:1335-1342. [DOI: 10.2214/ajr.19.22222] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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44
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Gamala M, Jacobs JWG, Heggelman BGF, Klaasen R. An unexpected manifestation of gout. Rheumatology (Oxford) 2020; 59:810. [DOI: 10.1093/rheumatology/kez426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mihaela Gamala
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Rheumatology, Northwest Clinics, Alkmaar and Den Helder, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ruth Klaasen
- Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
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45
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Li M, Gan Y, Shi D, Zhao J. Huge aneurysmal bone cyst secondary to giant cell tumor of the hand phalanx: a case report and related literature. BMC Cancer 2020; 20:233. [PMID: 32192464 PMCID: PMC7083031 DOI: 10.1186/s12885-020-06746-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 03/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aneurysmal bone cyst (ABC) secondary to Giant Cell Tumor of bone (GCT) is a rare lesion, of which the incidence is about 0.011 to 0.053 per 100,000 every year. There are only a few previous case reports, and most of them occur in the spine, long bones or flat bones. CASE PRESENTATION We report one case of a patient who complained of "progressive enlargement of the mass on right-hand fifth finger for 5 years with ulceration for 6 months". After the imaging examination in our hospital, it was diagnosed as a "huge bone tumor on the proximal phalanx of the right-hand fifth finger", then wide excision and amputation of the fifth finger were made. The pathological examination diagnosed the mass as aneurysmal bone cyst secondary to giant cell tumor, 13 × 8 × 6 cm3, with no local infiltration observed. No recurrence and metastasis occurred 18 months after the operation, and the patient recovered well. CONCLUSION In this report, we discuss the etiology, diagnosis, differentiation, and management of Aneurysmal bone Cyst secondary to Giant Cell Tumor of bone, and review previous case studies.
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Affiliation(s)
- Mingzhuo Li
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaokai Gan
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dingwei Shi
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhao
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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46
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Lu B, Lu Q, Huang B, Li C, Zheng F, Wang P. Risk factors of ultrasound-detected tophi in patients with gout. Clin Rheumatol 2020; 39:1953-1960. [PMID: 32062769 DOI: 10.1007/s10067-020-04947-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/04/2019] [Accepted: 01/13/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Tophus is a characteristic manifestation of advanced gout, the clinical significance of which is often underestimated. This study aimed to compare the difference of clinical and ultrasound features between gout patients with and without ultrasound-detected tophus and identify risk factors associated with the presence of ultrasonographic tophus in gout patients. MATERIALS AND METHODS A total of 85 gout patients were divided into tophaceous (n = 54) and non-tophaceous group (n = 31) according to the presence of ultrasound-detected tophus. All patients underwent ultrasound examination of the bilateral knee, ankle, and first metatarsophalangeal joint (MTP1). Clinical information and ultrasound findings were compared between the groups. A multivariate logistic regression analysis to determine possible risk factors is associated with the number of ultrasound-detected tophaceous joints. RESULTS Older age, longer gout duration, higher gout flare frequency, lower estimated glomerular filtration rate (eGFR), and higher prevalence of hypertension, hyperlipidemia, and ultrasound manifestations including double contour sign (DCS) and erosion were observed in tophaceous patients from the univariate analysis. Multivariable logistic regression analysis showed that eGFR and disease duration were independently associated with the number of tophaceous joints. Lower eGFR and longer course duration were associated with a higher risk of tophi (B = -0.020, 0.141; P = 0.009, 0.010, respectively). CONCLUSIONS The main factors that may influence the formation of tophi are disease duration and eGFR.Key Points• Lower eGFR and longer course duration are independent risk factors of tophi formation in gout patients.• The incidence of ultrasound manifestations including double contour sign (DCS) and erosion in patients with tophi were higher than those without tophi.
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Affiliation(s)
- Beilei Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qing Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
| | - Cuixian Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Fengyang Zheng
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Peilei Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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47
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Mulay SR, Steiger S, Shi C, Anders HJ. A guide to crystal-related and nano- or microparticle-related tissue responses. FEBS J 2020; 287:818-832. [PMID: 31829497 DOI: 10.1111/febs.15174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
Crystals and nano- and microparticles form inside the human body from intrinsic proteins, minerals, or metabolites or enter the body as particulate matter from occupational and environmental sources. Associated tissue injuries and diseases mostly develop from cellular responses to such crystal deposits and include inflammation, cell necrosis, granuloma formation, tissue fibrosis, and stone-related obstruction of excretory organs. But how do crystals and nano- and microparticles trigger these biological processes? Which pathomechanisms are identical across different particle types, sizes, and shapes? In addition, which mechanisms are specific to the atomic or molecular structure of crystals or to specific sizes or shapes? Do specific cellular or molecular mechanisms qualify as target for therapeutic interventions? Here, we provide a guide to approach this diverse and multidisciplinary research domain. We give an overview about the clinical spectrum of crystallopathies, about shared and specific pathomechanisms as a conceptual overview before digging deeper into the specialty field of interest.
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Affiliation(s)
- Shrikant R Mulay
- Pharmacology Division, CSIR-Central Drug Research Institute, Lucknow, India
| | - Stefanie Steiger
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Germany
| | - Chongxu Shi
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Germany
| | - Hans-Joachim Anders
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Germany
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48
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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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49
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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: 27] [Impact Index Per Article: 5.4] [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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50
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Impact of Dual-Energy CT Postprocessing Protocol for the Detection of Gouty Arthritis and Quantification of Tophi in Patients Presenting With Podagra: Comparison With Ultrasound. AJR Am J Roentgenol 2019; 213:1315-1323. [PMID: 31553656 DOI: 10.2214/ajr.19.21404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of our study was to compare ultrasound (US) tophus and monosodium urate (MSU) deposit detection and US tophus size in the metatarsophalangeal (MTP) 1 joint with dual-energy CT (DECT) using two DECT postprocessing protocols in patients presenting with podagra. SUBJECTS AND METHODS. Seventy-five consecutive patients with podagra (66 men and nine women; mean age, 65.6 years; age range, 33-88 years) and 75 control subjects with MTP 1 joint osteoarthritis (49 men and 26 women; mean age, 63.0 years; age range, 35-87 years) prospectively underwent US and DECT between 2016 and 2018 to assess the MTP 1 joint. Two Syngovia postprocessing DECT protocols with different minimum attenuation thresholds of 150 HU (DECT 150 protocol) versus 120 HU (DECT 120 protocol) and the same maximum attenuation threshold (500 HU) and constant kilovoltage setting of tubes A and B at 80 and 140 kVp were evaluated. Interobserver variability of the two DECT protocols was calculated and compared with that of US. RESULTS. The postprocessing DECT 150 protocol was positive for tophus detection in 55 of 75 patients (73.3%) with podagra, whereas the postprocessing DECT 120 protocol detected MSU deposits in all 75 patients (100%). Tophus size assessed using the DECT 120 protocol showed an improved correlation with tophus size detected on US (p < 0.01). Interobserver variability of DECT was improved when using the DECT 120 protocol (p < 0.01). CONCLUSION. The postprocessing DECT 120 protocol enables improved visualization of MSU deposits and provides more accurate information about tophus size that better correlates with tophus size on US compared with the standard postprocessing DECT 150 protocol.
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