An MRI assessment of chronic synovial-based inflammation in gout and its correlation with serum urate levels

Carter, John D.; Patelli, M.; Anderson, Scott R.; Prakash, Neelesh; Rodriquez, Ernesto J.; Bateman, Helen; Sterrett, Ashley; Valeriano, Joanne; Ricca, Louis

doi:10.1007/s10067-014-2644-9

Cited by 16 publications

(10 citation statements)

References 23 publications

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“…Consistent with other imaging studies in patients with gout , MRI detected significantly more erosions and also revealed that most subjects had evidence of synovitis at baseline. A key finding of the current study is that febuxostat treatment led to greater improvements in MRI‐detected synovitis over the 2‐year period compared with placebo treatment.…”

Section: Discussionsupporting

confidence: 88%

Effects of Febuxostat in Early Gout

Dalbeth

Saag

Palmer

et al. 2017

Arthritis & Rheumatology

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ObjectiveTo assess the effect of treatment with febuxostat versus placebo on joint damage in hyperuricemic subjects with early gout (1 or 2 gout flares).MethodsIn this double‐blind, placebo‐controlled study, 314 subjects with hyperuricemia (serum uric acid [UA] level of ≥7.0 mg/dl) and early gout were randomized 1:1 to receive once‐daily febuxostat 40 mg (increased to 80 mg if the serum UA level was ≥6.0 mg/dl on day 14) or placebo. The primary efficacy end point was the mean change from baseline to month 24 in the modified Sharp/van der Heijde erosion score for the single affected joint. Additional efficacy end points included change from baseline to month 24 in the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) scores for synovitis, erosion, and edema in the single affected joint, the incidence of gout flares, and serum UA levels. Safety was assessed throughout the study.ResultsTreatment with febuxostat did not lead to any notable changes in joint erosion over 2 years. In both treatment groups, the mean change from baseline to month 24 in the modified Sharp/van der Heijde erosion score for the single affected joint was minimal, with no between‐group differences. However, treatment with febuxostat significantly improved the RAMRIS synovitis score at month 24 compared with placebo treatment (change from baseline −0.43 versus −0.07; P <0.001), decreased the overall incidence of gout flares (29.3% versus 41.4%; P < 0.05), and improved serum UA control (62.8% versus 5.7%; P < 0.001). No major safety concerns were reported.ConclusionUrate‐lowering therapy with febuxostat improved magnetic resonance imaging–determined synovitis and reduced the incidence of gout flares in subjects with early gout.

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Section: Discussionsupporting

confidence: 88%

Effects of Febuxostat in Early Gout

Dalbeth

Saag

Palmer

et al. 2017

Arthritis & Rheumatology

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“…Acute 1 st MTP arthritis presenting as the manifestation of gout at disease onset, ranged from 43 to 76 % [ 20 , 32 – 35 ]. The frequency of acute 1 st MTP arthritis as the initial manifestation of gout was not significantly different between genders [ 34 – 36 ].…”

Section: Resultsmentioning

confidence: 99%

The first metatarsophalangeal joint in gout: a systematic review and meta-analysis

Stewart

Dalbeth

Vandal

et al. 2016

BMC Musculoskelet Disord

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BackgroundThe aim of this review was to qualitatively synthesise studies that have investigated characteristics of the first metatarsophalangeal joint (1st MTP) in gout and to undertake a meta-analysis to estimate the average prevalence of acute 1st MTP arthritis across studies in people with gout.MethodsStudies published in English were included if they involved participants who had a diagnosis of gout and presented original findings relating to the following outcome measures associated with the 1st MTP: epidemiology; clinical features; structural and functional characteristics; and microscopic and imaging features.ResultsForty-five studies were included in the qualitative synthesis. 1st MTP pain was a prominent feature in people with gout. People with 1st MTP gout reported walking- and general-disability. Structural and functional characteristics of 1st MTP gout included hallux valgus, osteoarthritis, and restricted joint motion. Successful crystal aspiration ranged from 81 to 91 % and positive crystal identification via microscopy ranged from 83 to 93 % in patients with a history of 1st MTP gout. Imaging features were common at the 1st MTP including the double contour sign, tophi and erosions. Eleven studies involving 2,325 participants were included in the meta-analysis, providing an estimate of the average prevalence of acute 1st MTP arthritis across studies of 73 % (95 % prediction interval 40–92 %; range 48–97 %; I2 = 93 %).Conclusions1st MTP acute arthritis is highly prevalent in people with gout and has a substantial impact on patient-reported pain and disability. Gout affects the structure and function of the 1st MTP. Microscopic and imaging studies have demonstrated crystal deposition and joint damage at the 1st MTP in people with gout.

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“…However, their diagnostic performance has been less studied than US and DECT. MRI provides information with regard to the size of tophi, crystal-induced inflammation such as synovitis, and joint damage including bone erosion 86–90. CT can also identify urate deposits but is more efficient in visualising bone damage 91–93.…”

Section: Discussionmentioning

confidence: 99%

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

et al. 2019

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Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

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An MRI assessment of chronic synovial-based inflammation in gout and its correlation with serum urate levels

Cited by 16 publications

References 23 publications

Effects of Febuxostat in Early Gout

Effects of Febuxostat in Early Gout

The first metatarsophalangeal joint in gout: a systematic review and meta-analysis

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

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