Gouty arthropathy: Review of clinico‐pathologic and imaging features

Abstract

Gout is a common inflammatory arthropathy in adults, with the prevalence increasing in males of older age. It occurs when monosodium urate (MSU) crystals are deposited in joints and connective tissue causing inflammation. The gold standard for the diagnosis of gout is the demonstration of negatively birefringent, needle-shaped MSU crystals through synovial fluid aspiration. However, this is an invasive technique and may not always be conclusive or feasible. Imaging techniques have been developed to aid in diagnosis of gout non-invasively. Radiography has a low utility in the early diagnosis of gout and demonstrates erosions in late stages. Ultrasound (US) has a high overall sensitivity in diagnosing gout with the 'double contour' sign having a high specificity. Magnetic resonance imaging is good at detecting tophi, bone marrow oedema and erosions, but has a limited role in diagnosis because of its high cost and limited availability. Conventional computed tomography (CT) has no role in the routine diagnosis of gout before development of erosions and tophi. A newer technology, dual-energy CT (DECT) has been shown to be able to detect MSU crystals burden with high accuracy. It has a higher specificity and lower sensitivity that US in gout diagnosis. However, because of radiation exposure and cost, it has a better utility in diagnosing clinically suspected gout complicated by other concurrent rheumatologic conditions or if radiography, US and synovial aspiration are inconclusive or not feasible. This paper will review the clinico-pathologic and imaging features of gouty arthropathy.

My Treatment Approach to Gout

“…Conventional computed tomography is not used in the routine diagnosis of gout, but it is excellent for identifying erosions. 30…”

“…Initially, when used, US may be the preferred method because of its lower cost, better availability, and lack of associated radiation. 30,43 In contrast, DECT is limited by higher cost, radiation, restricted availability, and lack of portability. Also, US and DECT can be used synergistically to identify patients with hydroxyapatite deposition.…”

Chlamydia-induced reactive arthritis diagnosed during gout flares

“…Gouty arthritis is characterized by the manifestation of metatarsophalangeal (MTP) arthritis, which develops in response to monosodium urate (MSU) crystals. [1] It sometimes occurs in large joints and multiple joints, and the prolonged inflammation that follows recurrent attacks of gout results in chronic gout. [2] Clinical manifestations of chronic gout are characterized by chronic synovitis, bony erosions, cartilage damage, and tophi formation.…”

Operative management of gouty tophi in the region of the olecranon: a case series

“… 2 , 20 The term ‘tophaceous disease’ in the setting of gout refers specifically to macroscopic depositions of monosodium urate that often form in extra-articular connective tissue structures, including bursae, tendons, and ligaments. 16 If left untreated, gouty tophi can lead to skin ulceration, infection, and compressive neuropathy, depending on the location and size of a given lesion. 3 , 22 The exact proportion of patients with gout who also display tophaceous deposits is unclear.…”