Urate‐Mediated inflammation in nodal osteoarthritis: Clinical and roentgenographic correlations

Abstract

We studied 25 patients with crystal-proven gout or roentgenographic evidence of gouty arthritis, or both, in finger joints involved with nodal osteoarthritis (OA). These patients were elderly (mean age 71.4 years), and 72% of them were receiving diuretic therapy. Roentgenographic findings, in addition to features typical of OA, included soft tissue densities (tophi), with or without calcification, large intraarticular erosions, characteristic nonmarginal cortical erosions, and periarticular osteolysis. We conclude that urate crystals mediate episodes of acute inflammation in certain patients with nodal OA. This association is noted primarily in elderly patients of both sexes, especially in those receiving diuretic therapy.

The pathogenesis of bone erosions in gouty arthritis

“…They hypothesised that transient increases in the urate concentration of resolving synovial effusions resulting from the differential permeability of synovium to urate and water in OA-affected joints might encourage nucleation and precipitation of MSU crystals. Others have also reported gouty arthritis in interphalangeal nodal hand OA 8–10. A significant association with OA was seen in a study by Roddy et al 11 at the first MTP joint, mid foot, knee and DIP joints.…”

The Role of Uric Acid and Other Crystals in Osteoarthritis

“…Simkin et al [9] were the first to describe gouty inflammation in joints affected by nodal OA. Later, Lally et al [10] studied a group of 25 patients with nodal OA and crystal-proven gout and concluded that MSU crystals mediate episodes of acute inflammation in older patients with nodal OA who have a history of diuretic use. The consensus among these early investigators was that gouty inflammation was "superimposed" on OA rather than causally related to OA development.…”

Dual-Energy Computed Tomography

“…Normal to low serum urate values have been noted in 12% to 43% of patients with acute episodes of gout. 13 Definitive diagnosis of gout therefore requires polarized light microscopic analysis of fluid aspirated from the involved joint demonstrating needle-shaped, negatively birefringent MSU crystals. The sensitivity of arthrocentesis for gout is in the range of 85% to 95% with specificity of 100%.…”