Session Information
Date: Monday, October 22, 2018
Title: Metabolic and Crystal Arthropathies – Basic and Clinical Science Poster I
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Gout is characterized by episodes of acute arthritis that are self-limiting. However, patients with gout can also develop tophi, bone erosions, joint deformity and dysfunction in advanced disease. Previous studies based on relatively small sample sizes or exclusively tophaceous gout cases suggested that the prevalence of erosions in gout could be substantial. However, the precise prevalence estimate, particularly among non-tophaceous gout cases remains unclear. The aim of this study was to determine the prevalence of erosions in patients with gout on urate-lowering therapy using dual-energy CT (DECT).
Methods:
DECT of the bilateral feet and ankles were prospectively obtained on 153 patients who fulfilled the 1977 ARA gout classification criteria and were on allopurinol ≥300mg daily for at least 3 months. Enrollment was conducted in a monitored fashion to ensure the population included approximately 25% of patients with palpable tophi and approximately 50% of patients with serum uric acid (SUA) <6 mg/dL. The presence of erosions was evaluated at 12 anatomic sites (1st-5th interphalangeal (IP) joints, 1st-5th MTP joints, tarsals, and Achilles tendon calcaneal insertion) in the feet and ankles by 2 radiologists familiar with interpreting DECT.
Results:
Our analysis included 153 patients (92% male) with gout (mean disease duration, 15 years) on allopurinol (mean duration of therapy, 5 years). Mean allopurinol dose was 333mg daily (range 300-750mg daily). Erosions in the feet and ankle were present in 72% of patients. Patients with tophi had significantly higher prevalence of erosions than those without tophi (83% vs 67% respectively, p=0.04). The three sites most commonly affected by erosions overall were the first MTP joint, tarsals, and first IP joint (68%, 38%, and 13%, respectively) (Table). The pattern of erosion involvement in the feet/ankles did not differ significantly based on tophus status.
Conclusion:
Among patients with gout on allopurinol, erosions in the feet and ankles are common, with 72% of all subjects demonstrating at least one erosion. The most frequent sites of erosions are the first MTP joint and the mid-foot areas, common locations of gouty arthritis. While patients with clinical tophi have a higher prevalence of erosions, 67% of patients without tophi had at least one erosion.
Table – Prevalence of erosions on DECT of feet/ankles
|
|
All Patients N=153 |
Clinical Tophi N=48 |
No Tophi N=105 |
|
Site |
Erosions |
Erosions |
Erosions |
|
Any site |
72% |
83% |
67% |
|
MTP 1 |
68% |
75% |
65% |
|
Tarsals |
38% |
46% |
34% |
|
IP 1 |
13% |
17% |
12% |
|
MTP 5 |
12% |
23% |
7% |
|
MTP 2 |
9% |
13% |
7% |
|
MTP 4 |
3% |
8% |
≤1% |
|
IP 2 |
3% |
4% |
3% |
|
MTP 3 |
3% |
6% |
2% |
|
Achilles |
≤ 1% |
2% |
≤1% |
|
IP 4 |
2% |
2% |
2% |
|
IP 3 |
≤ 1% |
0% |
≤1% |
|
IP 5 |
≤ 1% |
2% |
≤1% |
MTP = metatarsophalangeal joint; IP = interphalangeal joint
To cite this abstract in AMA style:
Yokose C, Zhang Y, Dalbeth N, Wei J, Nicolaou S, Baumgartner S, Hu J, Fung M, Choi HK. A Prospective Study Examining the Prevalence of CT Erosions in the Feet and Ankles of Patients with Gout Treated with Allopurinol [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/a-prospective-study-examining-the-prevalence-of-ct-erosions-in-the-feet-and-ankles-of-patients-with-gout-treated-with-allopurinol/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-prospective-study-examining-the-prevalence-of-ct-erosions-in-the-feet-and-ankles-of-patients-with-gout-treated-with-allopurinol/