Clinical Significance of Urate Deposition in Tendon: A Dual-Energy CT Study

In Young Kim¹, Yeonghee Eun², Ji young Chai³, Chan Hong Jeon⁴, Jinseok Kim⁵, Hyungjin Kim², Jaejoon Lee¹, Eun-Mi Koh² and Hoon-Suk Cha⁶, ¹Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South), ²Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South), ³Department of Rheumatology, Bundang Jesaeng Hospital, Seongnam, Korea, Republic of (South), ⁴Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea, Republic of (South), ⁵Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea, Republic of (South), ⁶Department of Medicine,Division of Rheumatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South)

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Computed tomography (CT), gout and hyperuricemia

Session Information

Date: Tuesday, November 7, 2017

Title: Metabolic and Crystal Arthropathies Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Dual-energy computed tomography (DECT) is advanced imaging modality that shows the deposition of monosodium urate (MSU) crystal in tissue as a color signal. In the 2015 American College of Rheumatology/European League Against Rheumatism gout classification criteria, DECT was included as one of the imaging modalities for diagnosis. The MSU crystal deposit around the symptomatic joint is considered as positive finding, but the clinical significance of urate deposition around the tendon is still unclear.

The aim of this study was to compare the clinical characteristics and DECT findings in people with MSU crystal deposition in the joints and people with urate deposition only in the tendons.

Methods:

DECT was performed in 71 patients who complained of recurrent painful swelling of the foot and/or ankle joints, and 35 of them showed MSU crystal deposition in the joints on DECT. The patients were divided into two groups according to the location of uric acid deposition on DECT. We analyzed the differences in clinical features and imaging findings between the two groups.

Results:

The mean age of the patients was 50 ± 14 years, and 67 patients (94%) were male. All of patients who had shown the deposition of uric acid crystals in joints on DECT had history of typical gout attacks, but 29 (81%) of those only in tendons on DECT had experienced typical gout attacks (p=0.011). The overall mean uric acid level in all patients was as high as 7.5 ± 2.2 mg/dL. The uric acid level was found to be higher in patients with joint involvement, but this difference was not statistically significant. The concordance rate between the symptomatic sites and the urate deposition sites was 91% in patients with joint deposition, but the rate was only 6% in patients without joint deposition (p<0.001). There were 4 patients (11%) who showed gouty erosion without MSU crystal deposition in joints on DECT.

Conclusion:

The MSU crystal deposition in the tendon was not correlated well with clinical features. However, in some patients, MSU crystal deposition may be observed only in the tendon, even with gouty erosion in joints. Therefore, careful interpretation of the DECT is necessary.

Disclosure: I. Y. Kim, None; Y. Eun, None; J. Y. Chai, None; C. H. Jeon, None; J. Kim, None; H. Kim, None; J. Lee, None; E. M. Koh, None; H. S. Cha, None.

To cite this abstract in AMA style:

Kim IY, Eun Y, Chai JY, Jeon CH, Kim J, Kim H, Lee J, Koh EM, Cha HS. Clinical Significance of Urate Deposition in Tendon: A Dual-Energy CT Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/clinical-significance-of-urate-deposition-in-tendon-a-dual-energy-ct-study/. Accessed .

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