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Pârvănescu CD, Bărbulescu AL, Biță CE, Dinescu ȘC, Trașcǎ BA, Firulescu SC, Vreju FA. Ultrasound Features in Gout: An Overview. Med Sci (Basel) 2024; 12:37. [PMID: 39189200 PMCID: PMC11348250 DOI: 10.3390/medsci12030037] [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: 06/17/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024] Open
Abstract
The accurate diagnosis of gout frequently constitutes a challenge in clinical practice, as it bears a close resemblance to other rheumatologic conditions. An undelayed diagnosis and an early therapeutic intervention using uric acid lowering therapy (ULT) is of the utmost importance for preventing bone destruction, the main point of managing gout patients. Advanced and less invasive imaging techniques are employed to diagnose the pathology and ultrasonography (US) stands out as a non-invasive, widely accessible and easily reproducible method with high patient acceptability, enabling the evaluation of the full clinical spectrum in gout. The 2023 EULAR recommendations for imaging in diagnosis and management of crystal-induced arthropathies in clinical practice state that US is a fundamental imagistic modality. The guidelines underline its effectiveness in detecting crystal deposition, particularly for identifying tophi and the double contour sign (DCS). Its utility also arises in the early stages, consequent to synovitis detection. US measures of monosodium urate (MSU) deposits are valuable indicators, sensitive to change consequent to even short-term administration of ULT treatment, and can be feasibly used both in current daily practice and clinical trials. This paper aimed to provide an overview of the main US features observed in gout patients with reference to standardized imaging guidelines, as well as the clinical applicability both for diagnosis accuracy and treatment follow-up. Our research focused on summarizing the current knowledge on the topic, highlighting key data that emphasize gout as one of the few rheumatological conditions where US is recognized as a fundamental diagnostic and monitoring tool, as reflected in the most recent classification criteria.
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Affiliation(s)
- Cristina Dorina Pârvănescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Andreea Lili Bărbulescu
- Department of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cristina Elena Biță
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Ștefan Cristian Dinescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Beatrice Andreea Trașcǎ
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Sineta Cristina Firulescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Florentin Ananu Vreju
- Department of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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Yokose C, Eide SE, Huber FA, Simeone FJ, Ghoshhajra BB, Shojania K, Nicolaou S, Becce F, Choi HK. Frequently Encountered Artifacts in the Application of Dual-Energy Computed Tomography to Cardiovascular Imaging for Urate Crystals in Gout: A Matched-Control Study. Arthritis Care Res (Hoboken) 2024; 76:953-963. [PMID: 38317327 PMCID: PMC11209827 DOI: 10.1002/acr.25312] [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: 06/14/2023] [Revised: 11/02/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE There is surging interest in using dual-energy computed tomography (DECT) to identify cardiovascular monosodium urate (MSU) deposits in patients with gout. We sought to examine the prevalence and characterization of cardiovascular DECT artifacts using non-electrocardiogram (EKG)-gated DECT pulmonary angiograms. METHODS We retrospectively reviewed non-EKG-gated DECT pulmonary angiograms performed on patients with and without gout at a single academic center. We noted the presence and locations of vascular green colorization using the default postprocessing two-material decomposition algorithm for MSU. The high- and low-energy grayscale images and advanced DECT measurements were used to determine whether they were true findings or artifacts. We classified artifacts into five categories: streak, contrast medium mixing, misregistration due to motion, foreign body, and noise. RESULTS Our study included CT scans from 48 patients with gout and 48 age- and sex-matched controls. The majority of patients were male with a mean age of 67 years. Two independent observers attributed all areas of vascular green colorization to artifacts. The most common types of artifacts were streak (56% vs 57% between patients and controls, respectively) and contrast medium mixing (51% vs 65%, respectively). Whereas some of the default DECT measurements of cardiovascular green colorization were consistent with values reported for subcutaneous tophi, advanced DECT measurements were not consistent with that of tophi. CONCLUSION Artifacts that could be misconstrued as cardiovascular MSU deposits were commonly identified in patients with and without gout on non-EKG-gated DECT pulmonary angiograms. These artifacts can inform future vascular DECT studies on patients with gout to minimize false-positive findings.
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Affiliation(s)
- Chio Yokose
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Florian A. Huber
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - F. Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian B. Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, MA
| | - Kamran Shojania
- Division of Rheumatology, Department of Medicine, Vancouver General Hospital
- Arthritis Research Canada, Vancouver BC
| | | | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Covello A, Toprover M, Oh C, Leroy G, Kumar A, LaMoreaux B, Mechlin M, Fields TR, Pillinger MH, Becce F. Skeletal muscle mass and quality in gout patients versus non-gout controls: A computed tomography imaging study. Joint Bone Spine 2024; 91:105743. [PMID: 38795766 DOI: 10.1016/j.jbspin.2024.105743] [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: 02/01/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Patients with gout are at elevated risk of multiple vascular and metabolic comorbidities. Whether they are also at risk of sarcopenia, which is known to affect patients with other rheumatic diseases, has not been previously assessed. We examined whether patients with gout have decreased lumbar muscle quality and quantity, indicating an association between gout and sarcopenia. METHODS Fifty gout subjects and 25 controls, ages 45-80, underwent computed tomography imaging of the lumbosacral spine. We measured muscle quantity (skeletal muscle area [SMA] and index [SMI]) and quality (skeletal muscle radiation attenuation [SMRA] and intermuscular adipose tissue [IMAT] area and index [IMATI]) of the psoas and erector spinae muscles at the L3 level. RESULTS Seventy subjects (45 gout and 25 controls) were included in the analysis. Gout subjects had higher BMI, more kidney disease and hypertension, lower exercise frequency, and higher mean serum urate and creatinine vs. controls. Lumbar SMRA was significantly lower in gout subjects vs. controls, indicating reduced muscle quality. Lumbar IMAT area was significantly higher in gout subjects vs. controls, as was lumbar IMATI, indicating increased muscle adiposity. These differences persisted after adjusting for potential confounders. In contrast, there was no significant difference between gout and control groups in lumbar SMA or lumbar SMI, suggesting that muscle quantity may not be routinely affected by the diagnosis of gout. CONCLUSIONS Gout patients exhibit decreased lumbar muscle quality compared with controls, consistent with an association between gout and sarcopenia.
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Affiliation(s)
- Allyson Covello
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA; Rheumatology Section, NY Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, 423 E 23rd Street, New York, NY, USA.
| | - Michael Toprover
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA; Rheumatology Section, NY Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, 423 E 23rd Street, New York, NY, USA
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, 550, First Avenue, New York, NY, USA
| | - Gregoire Leroy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, 46, rue du Bugnon, 1011 Lausanne, Switzerland
| | - Ada Kumar
- Amgen Inc, 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Brian LaMoreaux
- Amgen Inc, 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Michael Mechlin
- Division of Musculoskeletal Radiology, Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA
| | - Theodore R Fields
- Division of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, USA
| | - Michael H Pillinger
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA; Rheumatology Section, NY Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, 423 E 23rd Street, New York, NY, USA
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, 46, rue du Bugnon, 1011 Lausanne, Switzerland
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Ye Y, Deng F, Luo J, Huang X, Qu X, Zhuang S. Tophaceous gouty arthritis with spondylolysis: a case report. J Surg Case Rep 2023; 2023:rjad689. [PMID: 38163058 PMCID: PMC10755092 DOI: 10.1093/jscr/rjad689] [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] [Received: 10/31/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Spinal gout is a rare occurrence, and the combination of gout with lumbar spondylolysis has not been reported. We present a unique case involving a 29-year-old male who complained of low back pain for 1 month. Computed tomography and magnetic resonance imaging revealed articular subchondral erosions and a mass in the left L5-S1 facet joints. Initially treated for a spinal infection, the patient subsequently underwent lumbar spinal canal decompression and fusion, achieving complete relief. Postoperative pathology confirmed the spinal lesions to be tophaceous gout. Dual-energy CT or biopsy can assist in confirming the diagnosis. This report discusses another rare case of tophaceous gouty arthritis with spondylolysis to be added to the literature.
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Affiliation(s)
- Yongsheng Ye
- Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongcheng District, Dongguan City, Guangdong Province, 523000, China
| | - Fangyue Deng
- Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongcheng District, Dongguan City, Guangdong Province, 523000, China
| | - Jiahui Luo
- Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongcheng District, Dongguan City, Guangdong Province, 523000, China
| | - Xiongfei Huang
- Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongcheng District, Dongguan City, Guangdong Province, 523000, China
| | - Xiliang Qu
- Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongcheng District, Dongguan City, Guangdong Province, 523000, China
| | - Shabin Zhuang
- Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongcheng District, Dongguan City, Guangdong Province, 523000, China
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