2016
DOI: 10.1186/s13075-016-1105-z
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Urate crystal deposition and bone erosion in gout: ‘inside-out’ or ‘outside-in’? A dual-energy computed tomography study

Abstract: BackgroundIt is currently unknown whether bone erosion in gout occurs through an ‘inside-out’ mechanism due to direct intra-osseous crystal deposition or through an ‘outside-in’ mechanism from the surface of bone. The aim of this study was to examine the mechanism (‘outside-in’ vs. ‘inside-out’) of monosodium urate (MSU) crystal deposition in bone erosion in gout. Specifically, we used three-dimensional dual-energy computed tomography (DECT) to analyse the positional relationship between bone and MSU crystal d… Show more

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Cited by 38 publications
(15 citation statements)
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“…However, joint effusion was negatively correlated with bone erosion. We speculate that, because bone erosion occurs through an “outside‐in” mechanism , exudative inflammation may prevent direct invasion of the tophus (or granulomatous synovitis) through the articular cartilage into bone and dilute MSU‐induced inflammatory cytokines. These results suggest that long‐term inflammatory rather than acute inflammatory stimuli that promote progressive synovial thickening are a risk factor for bone erosion.…”
Section: Discussionmentioning
confidence: 99%
“…However, joint effusion was negatively correlated with bone erosion. We speculate that, because bone erosion occurs through an “outside‐in” mechanism , exudative inflammation may prevent direct invasion of the tophus (or granulomatous synovitis) through the articular cartilage into bone and dilute MSU‐induced inflammatory cytokines. These results suggest that long‐term inflammatory rather than acute inflammatory stimuli that promote progressive synovial thickening are a risk factor for bone erosion.…”
Section: Discussionmentioning
confidence: 99%
“…MSU crystals can deposit in joints or soft tissue structures and induce an acute inflammatory arthritis (gout flare) or present as tophi, which represent organized collections of MSU crystals with surrounding chronic granulomatous inflammatory tissue . MSU crystals also contribute to the development of bone erosion in tophaceous gout; advanced imaging studies have demonstrated a very close relationship between tophi and bone erosion in patients with gout , and laboratory studies have demonstrated that MSU crystals can influence bone cells (osteoclasts, osteoblasts, and osteocytes), both directly and indirectly, toward a proresorptive state .…”
Section: Introductionmentioning
confidence: 99%
“…DECT has excellent reproducibility in the assessment of MSU crystal burden in people with gout . Through visualization of conventional CT images generated at the time of scanning, DECT also provides gold standard visualization of bone erosion .…”
Section: Introductionmentioning
confidence: 99%
“…This may indicate tophaceous compromise of the distal-to-proximal blood supply of the talus leading to cortical destabilization (1,2). This case is not intended to confirm or refute a recent dual-energy CT study of gouty erosions, which found that no urate was deposited in the bone, but only on the surface in cortical defects of erosions (3). We present this unique case simply to raise awareness and cannot draw any pathophysiologic conclusions.…”
Section: Replymentioning
confidence: 79%