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Gadolinium-enhanced MRI features of acute gouty arthritis on top of chronic gouty involvement in different joints

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Abstract

The aims of the current study are to describe gadolinium-enhanced MRI features of an acute flare of established gouty arthritis in different joints and to examine a possible association between serum uric acid and MRI signs indicative of ongoing inflammation and/or structural joint damage as well as association with disease characteristics and laboratory findings. Twenty-seven male patients with established chronic gout agreed to participate, mean age 47.6 years, and mean disease duration in months 43.2 (±31.8). For all patients, detailed demographic, disease characteristics, and laboratory findings were obtained and correlated with MRI findings. In 27 patients with established gout, a total of 50 MRI studies were performed of the following joints: feet joints (n = 23), ankles (n = 18), knees (n = 5), and hand and wrist joints (n = 4). MRI revealed capsular thickening in 19 patients, bone marrow edema (BME) in 15, soft tissue edema (STE) in 20, joint effusion in 21, bone erosions in 17, cartilaginous erosions in 4, and tenosynovitis in 9 cases. In 17 cases, tophaceous lesions were found. Post contrast MRI showed synovial thickening in seven cases. Positive correlations were observed between serum uric acid levels and the following MRI findings: capsular thickening (r = 0.552, p = 0.003), BME (r = 0.668, p ≤ 0.0001), STE (r = 0.559, p = 0.002), and tenosynovitis (r = 0.513, p = 0.006). Using MRI in chronic gout, important features can be detected like BME, minute cartilaginous erosions, and hypertrophic synovial inflammation in post contrast MR images. Serum uric acid (SUA) was positively correlated with capsular thickening, BME, STE, and tenosynovitis.

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References

  1. Gonzalez EB (2012) An update on the pathology and clinical management of gouty arthritis. Clin Rheumatol 31:13–21. doi:10.1007/s10067-011-1877-0

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bolzetta F, Veronese N, Manzato E, Sergi G (2012) Tophaceous gout in the elderly: a clinical case review. Clin Rheumatol 31:1127–1132. doi:10.1007/s10067-012-1956-x

    Article  PubMed  Google Scholar 

  3. Robier C, Stettin M, Quehenberger F, Neubauer M (2014) Cytospin preparations are superior to common smears in the detection of monosodium urate crystals in low-cellular synovial fluids. Clin Rheumatol 33:1797–1800. doi:10.1007/s10067-014-2619-x

    Article  PubMed  Google Scholar 

  4. Carter JD, Kedar RP, Anderson SR, Osorio AH, Albritton NL, Gnanashanmugam S, Valeriano J, Vasey FB, Ricca LR (2009) An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology (Oxford) 48:1442–1446. doi:10.1093/rheumatology/kep278

    Article  Google Scholar 

  5. Chen CK, Chung CB, Yeh L, Pan HB, Yang CF, Lai PH, Liang HL, Resnick D (2000) Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients. Am J Roentgenol 175:655–659

    Article  CAS  Google Scholar 

  6. Johnson TR, Weckbach S, Kellner H, Reiser MF, Becker CR (2007) Dual-energy computed tomographic molecular imaging of gout. Arthritis Rheum 56:2809

    Article  PubMed  Google Scholar 

  7. Popp JD, Bidgood WD Jr, Edwards LN (1996) Magnetic resonance imaging of tophaceous gout in the hands and wrists. Semin Arthritis Rheum 25:282–289

    Article  CAS  PubMed  Google Scholar 

  8. Narváez JA, Narváez J, Ortega R, De Lama E, Roca Y, Vidal N (2003) Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlations. Am J Roentgenol 181:761–769

    Article  Google Scholar 

  9. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF (1997) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20:895–900

    Article  Google Scholar 

  10. Boutry N, Lardé A, Lapègue F, Solau-Gervais E, Flipo RM, Cotten A (2003) Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. J Rheumatol 30:671–679

    PubMed  Google Scholar 

  11. Emad Y, Ragab Y, Shaarawy A, Raafat H, El-Kiki HA, Rasker JJ (2008) Enhanced MRI in early undifferentiated oligoarthritis of the knee joints: improvements already visible after 2 months of DMARDs treatment. Clin Rheumatol 27:1177–1182. doi:10.1007/s10067-008-0935-8

    Article  PubMed  Google Scholar 

  12. Chen CK, Yeh LR, Pan HB, Yang CF, Lu YC, Wang JS, Resnick D (1999) Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skelet Radiol 28:75–80

    Article  CAS  Google Scholar 

  13. Yu JS, Chung C, Recht M, Dailiana T, Jurdi R (1997) MR imaging of tophaceous gout. Am J Roentgenol 168:523–527

    Article  CAS  Google Scholar 

  14. Gerster JC, Landry M, Dufresne L, Meuwly JY (2002) Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis 61:52–54

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Perez-Ruiz F, Naredo E (2007) Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol 19:128–133

    Article  PubMed  Google Scholar 

  16. Puig JG, de Miguel E, Castillo MC, Rocha AL, Martínez MA, Torres RJ (2008) Asymptomatic hyperuricemia: impact of ultrasonography. Nucleosides Nucleotides Nucleic Acids 27:592–595. doi:10.1080/15257770802136040

    Article  CAS  PubMed  Google Scholar 

  17. Thiele RG, Schlesinger N (2007) Diagnosis of gout by ultrasound. Rheumatology (Oxford) 46:1116–1121

    Article  CAS  Google Scholar 

  18. Poh YJ, Dalbeth N, Doyle A, McQueen FM (2011) Magnetic resonance imaging bone edema is not a major feature of gout unless there is concomitant osteomyelitis: 10-year findings from a high-prevalence population. J Rheumatol 38:2475–2481. doi:10.3899/jrheum.110477

    Article  PubMed  Google Scholar 

  19. Chhana A, Callon KE, Pool B, Naot D, Gamble GD, Dray M, Pitto R, Bentley J, McQueen FM, Cornish J, Dalbeth N (2013) The effects of monosodium urate monohydrate crystals on chondrocyte viability and function: implications for development of cartilage damage in gout. J Rheumatol 40:2067–2074. doi:10.3899/jrheum.130708

    Article  CAS  PubMed  Google Scholar 

  20. Carter JD, Patelli M, Anderson SR, Prakash N, Rodriquez EJ, Bateman H, Sterrett A, Valeriano J, Ricca LR (2014) An MRI assessment of chronic synovial-based inflammation in gout and its correlation with serum urate levels. Clin Rheumatol. doi:10.1007/s10067-014-2644-9

    PubMed  Google Scholar 

  21. Dalbeth N, Milligan A, Doyle AJ, Clark B, McQueen FM (2012) Characterization of new bone formation in gout: a quantitative site-by-site analysis using plain radiography and computed tomography. Arthritis Res Ther 14:R165. doi:10.1186/ar3913

    Article  PubMed Central  PubMed  Google Scholar 

  22. Jansen TL (2012) Rheumatology meets radiology in the hot soup of Gutta. Arthritis Res Ther 14(6):126. doi:10.1186/ar4068

    Article  PubMed Central  PubMed  Google Scholar 

  23. Dalbeth N, Collis J, Gregory K, Clark B, Robinson E, McQueen FM (2007) Tophaceous joint disease strongly predicts hand function in patients with gout. Rheumatology 46:1804–1807

    Article  CAS  PubMed  Google Scholar 

  24. Wu H, Xue J, Ye L, Zhou Q, Shi D, Xu R (2014) The application of dual-energy computed tomography in the diagnosis of acute gouty arthritis. Clin Rheumatol 33:975–979. doi:10.1007/s10067-014-2606-2

    Article  PubMed  Google Scholar 

  25. Shi D, Xu JX, Wu HX, Wang Y, Zhou QJ, Yu RS (2014) Methods of assessment of tophus and bone erosions in gout using dual-energy CT: reproducibility analysis. Clin Rheumatol. doi:10.1007/s10067-014-2725-9

  26. McQueen FM, Doyle A, Dalbeth N (2011) Imaging in gout-what can we learn from MRI, CT, DECT and US? Arthritis Res Ther 13:246. doi:10.1186/ar3489

    Article  PubMed Central  PubMed  Google Scholar 

  27. Schumacher HR Jr, Becker MA, Edwards NL, Palmer WE, MacDonald PA, Palo W, Joseph-Ridge N (2006) Magnetic resonance imaging in the quantitative assessment of gouty tophi. Int J Clin Pract 60:408–414

    Article  PubMed  Google Scholar 

  28. Richette P, Perez-Ruiz F, Doherty M, Jansen TL, Nuki G, Pascual E, Punzi L, So AK, Bardin T (2014) Improving cardiovascular and renal outcomes in gout: what should we target? Nat Rev Rheumatol. doi:10.1038/nrrheum.2014.124

    PubMed  Google Scholar 

  29. Jansen TL, Berendsen D, Crisan TO, Cleophas MC, Janssen MC, Joosten LA (2014) New gout test: enhanced ex vivo cytokine production from PBMCS in common gout patients and a gout patient with Kearns-Sayre syndrome. Clin Rheumatol 33:1341–1346. doi:10.1007/s10067-014-2620-4

    Article  PubMed  Google Scholar 

  30. Jansen TL, Rasker JJ (2011) Therapeutic consequences of crystals in the synovial fluid: a review for clinicians. Clin Exp Rheumatol 29:1032–1039

    PubMed  Google Scholar 

Download references

Conflict of interest

All the authors responsible for this work declare no conflict of interests.

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Authors and Affiliations

  1. Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Yasser Emad & Mayada A. Abd-Allah

  2. Rheumatology and Rehabilitation Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia

    Yasser Emad

  3. Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Yasser Ragab

  4. Radiology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia

    Yasser Ragab

  5. Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Ahmed El-Naggar

  6. Orthopedic Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia

    Ahmed El-Naggar

  7. Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

    Nashwa El-Shaarawy

  8. Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Asyut, Egypt

    Rania M. Gamal

  9. Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Ahmed Fathy

  10. Internal Medicine Department, Nephrology Unit, Agouza Police Hospital, Cairo, Egypt

    Mona Hawass

  11. Rheumatology Department, University of Twente, Enschede, The Netherlands

    Johannes J. Rasker

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  1. Yasser Emad
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  2. Yasser Ragab
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  3. Ahmed El-Naggar
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  4. Nashwa El-Shaarawy
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  5. Mayada A. Abd-Allah
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  6. Rania M. Gamal
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  7. Ahmed Fathy
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  8. Mona Hawass
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  9. Johannes J. Rasker
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Correspondence to Yasser Emad.

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Emad, Y., Ragab, Y., El-Naggar, A. et al. Gadolinium-enhanced MRI features of acute gouty arthritis on top of chronic gouty involvement in different joints. Clin Rheumatol 34, 1939–1947 (2015). https://doi.org/10.1007/s10067-015-2895-0

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  • DOI: https://doi.org/10.1007/s10067-015-2895-0

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