Abstract
To establish whether dual-energy CT (DECT) is a diagnostic tool, i.e., associated with initiation or discontinuation of a urate lowering drug (ULD). Secondly, to determine whether DECT results (gout deposition y/n) can be predicted by clinical and laboratory variables. Digital medical records of 147 consecutive patients with clinical suspicion of gout were analyzed retrospectively. Clinical data including medication before and after DECT, lab results, and results from diagnostic joint aspiration and DECT were collected. The relationship between DECT results and clinical and laboratory results was evaluated by univariate regression analyses; predictors showing a p < 0.10 were entered in a multivariate logistic regression model with the DECT result as outcome variable. A backward stepwise technique was applied. After the DECT, 104 of these patients had a clinical diagnosis of gout based on the clinical judgment of the rheumatologist, and in 84 of these patients, the diagnosis was confirmed by demonstration of monosodium urate (MSU) crystals in synovial fluid (SF) or by positive DECT. After DECT, the current ULD was modified in 33 (22.4%) of patients; in 29 of them, ULD was started and in 1 it was intensified. Following DECT, the current ULD was stopped in three patients. In the multivariable regression model, cardiovascular disease (OR 3.07, 95% CI 1.26–7.47), disease duration (OR 1.008, 95% CI 1.001–1.016), frequency of attack (OR 1.23, 95% CI 1.07–1.42), and creatinine clearance (OR 2.03, 95% CI 0.91–1.00) were independently associated with positive DECT results. We found that the DECT result increases the confidence of the prescribers in their decision to initiation or discontinuation of urate lowering therapy regimen in of mono- or oligoarthritis. It may be a useful imaging tool for patients who cannot undergo joint aspiration because of contraindications or with difficult to aspirate joints, or those who refuse joint aspiration. We also suggest the use of DECT in cases where a definitive diagnosis cannot be made from signs, symptoms, and MSU analysis alone.
Highlights
Gout is a disease characterized by accumulation of monosodium urate (MSU) in joints and tissues [1]
The following variables were collected: patient demographics, dual-energy computed tomography (CT) (DECT) results, initiation or discontinuation of uric acid lowering drugs (ULD), frequency of gouty attacks, and uric acid levels between flares in patients with changes in therapy based on DECT
We registered clinical, laboratory, and imaging features known from the literature as predictor variables of DECT results, i.e., gender, body mass index (BMI in kg/ m2), cardiovascular disease, diabetes mellitus, disease duration, frequency of attacks, uric acid levels between flares, creatinine clearance, joint involvement at the moment of DECT, MTP1 joint involvement in the past, result of microscopy (MSU crystals yes/no) around the date of the DECT, and scanned joints by DECT: hands, feet, knees, elbows, and other joints
Summary
Gout is a disease characterized by accumulation of monosodium urate (MSU) in joints and tissues [1]. Gout is associated with joint damage and increased cardiovascular morbidity and mortality [3,4,5]. Attacks of arthritis caused by gout are very painful, and the affected persons are often not able to perform normal daily activities and work [6, 7]. Prevention with uric acid lowering drugs (ULD) of new attacks of gout and joint damage is an important goal of the treatment. ULD are very effective, Clin Rheumatol (2018) 37:1879–1884 especially if started early in the course of the disease [8,9,10]. An early and accurate diagnosis of gout is crucial for targeted treatment and rapid alleviation of symptoms
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