Radiology Medical News about gout;normal plain radiographs

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An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs
Rheumatology, 09/15/09

Carter JD et al. – A large percentage of patients with gout and normal plain radiographs have occult destructive arthropathy that is only detected by advanced imaging such as MRI and/or US. MRI appears to be much more sensitive than US at detecting these findings.

Methods

Study consisted of two visits
Visit 1, a plain radiograph of the ‘index joint’ was obtained
‘Index joint’ was defined as a joint that has had the most acute attacks of gout historically
Index joint plain radiograph had to be free of erosive damage in order for subject to qualify for Visit 2.
Visit 2, the subject had an MRI with contrast and an US of the index joint. Each subject also had an MRI and US of an ‘asymptomatic joint’
The primary endpoint was erosive changes on the MRI and/or US of the index joint. Secondary endpoints included erosive changes on the asymptomatic joint as well as bone marrow oedema (BME) (on MRI), synovial pannus (SP), soft tissue tophi (STT) or oedema (STE) on either the index or asymptomatic joint

Results

26 males; 1 female completed both visits
Average age and disease duration were 55.1 years (range 21–75 years) and 6.8 years (range 0.25–25 years)
Average serum uric acid level over the past 5 years was 8.09 mg/dl ; their average on the day of Visit 1 was 7.96 mg/dl
First MTP was the most common index joint (17) followed by the ankle (5), mid-tarsal (2), knee (2) and wrist (1)
Knee was the most common asymptomatic joint (21) followed by wrist (3), MTP (2) and ankle (1)
All subjects had both MRIs; one subject refused US
15 subjects had erosions on MRI of their index joint; only 1 subject had erosions identified in the index joint by US
On secondary endpoints on the index joint, the MRI detected SP (13), BME (4), STE (3) and STT (0); the US detected SP (1), STT (1) and STE (0)
No positive findings by US in asymptomatic joint

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