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Crystal arthropathies
Original article
Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT
  1. Penny Wang1,
  2. Stacy E Smith2,3,
  3. Rajesh Garg4,
  4. Fengxin Lu1,
  5. Alyssa Wohlfahrt1,
  6. Anarosa Campos1,
  7. Kathleen Vanni1,
  8. Zhi Yu1,
  9. Daniel H Solomon1,5 and
  10. Seoyoung C Kim1,5
  1. 1 Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Seoyoung C Kim; sykim{at}bwh.harvard.edu

Abstract

Objectives Dual-energy CT (DECT) scan is a sensitive and specific tool used to visualise and quantify monosodium urate (MSU) crystal deposits in the joints. Few studies have examined MSU crystal deposits in patients with asymptomatic hyperuricemia (ie, hyperuricemia in the absence of gout) using DECT.

Methods We conducted a prospective, non-interventional cross-sectional study to detect MSU crystal deposits on DECT scans among patients with asymptomatic hyperuricemia. We also examined patient factors associated with subclinical MSU crystal deposits. Out of 130 subjects aged ≥40 years with metabolic syndrome screened for serum uric acid (sUA) levels ≥6.5 mg/dL, 46 underwent a foot/ankle DECT scan.

Results The mean age of the study participants was 62 (±8) years, 41% were men and the mean sUA level was 7.8 (±1.0) mg/dL. Seven (15%) of 46 patients had MSU crystal deposits on DECT with a mean total volume of 0.13 (±0.14) cm3. In the univariable logistic regression analysis, older age had a significant association with presence of MSU crystal deposits (OR 1.20, 95% CI 1.03 to 1.39), but sUA did not (OR 1.36, 95% CI 0.63 to 2.95). In the univariable analysis, sUA levels showed a trend towards a modest linear association (β=0.11, P=0.09) with total volume of MSU crystal deposits.

Conclusions Fifteen per cent of patients with asymptomatic hyperuricemia had subclinical MSU crystal deposits on foot/ankle DECT scans. Older age, but not sUA, was significantly associated with presence of subclinical MSU crystal deposits among patients with asymptomatic hyperuricemia. Clinical significance of these subclinical MSU crystal deposits needs to be determined.

  • gout
  • synovial fluid
  • inflammation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000593

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    Footnotes

    • Contributors All the authors met the Uniform Requirements for Manuscripts Submitted to Biomedical Journals criteria for authorship.

    • Funding This study was funded by an investigator-initiated research grant from AstraZeneca.

    • Disclaimer This study was conducted by the authors independent of the sponsor. The sponsor was given the opportunity to make non-binding comments on a draft of the manuscript, but the authors retained the right of publication and to determine the final wording.

    • Competing interests SCK has received research support from Lilly, Pfizer, Genentech, Bristol-Myers Squibb and Merck for unrelated studies. DHS has received research/funding support from Amgen, AstraZeneca, Genentech, Lilly and CORRONA, received royalties from UpToDate and served in unpaid roles in studies funded by Lilly, Novartis and Pfizer.

    • Patient consent Not required.

    • Ethics approval Partners Healthcare Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.