Abstract
Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate (MSU) crystals in peripheral joints and tissue. Detection of MSU crystals is essential for definitive diagnosis, however the gold standard is an invasive process which is rarely utilized. In fact, most patients are diagnosed or even misdiagnosed based on manifested clinical signs, as indicated by the unchanged premature mortality among gout patients over the past decade, although effective treatment is now available. An alternative, non-invasive approach for the detection of MSU crystals is X-ray dark-field radiography. In our work, we demonstrate that dark-field X-ray radiography can detect naturally developed gout in animals with high diagnostic sensitivity and specificity based on the in situ measurement of MSU crystals. With the results of this study as a potential basis for further research, we believe that X-ray dark-field radiography has the potential to substantially improve gout diagnostics.
Highlights
Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate (MSU) crystals in peripheral joints and tissue
The analysis of synovial fluid and the identification of MSU crystals using polarized light microscopy is the diagnostic standard of reference, studies have shown that this method is rarely used in primary care facilities[7]
MSU crystals distributed over ten separate regions could be identified in four of the eight excised limbs via crystal analysis using light microscopy, and the presence of a dark-field signal could be visually observed in MSU-positive regions
Summary
Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate (MSU) crystals in peripheral joints and tissue. Non-invasive approach for the detection of MSU crystals is X-ray dark-field radiography. We demonstrate that dark-field X-ray radiography can detect naturally developed gout in animals with high diagnostic sensitivity and specificity based on the in situ measurement of MSU crystals. Chronic joint lesions caused by gout can be detected via conventional radiography, which is not suitable for the diagnosis of an acute gout a rthritis[8] Further imaging techniques such as ultrasound and dual-energy CT (DECT) have shown their potential in early diagnosis of gout and have been integrated into the new American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) classification criteria together with clinical characteristics[9].
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