The volume and prevalence of peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) were found to be similar among patients with and without gout, according to study results published in Seminars in Arthritis and Rheumatism.
Researchers sought to assess DECT-based vascular MSU-coded plaques in gout and determine their association with soft-tissue MSU burden.
A prospective study (ClinicalTrials.gov Identifier: NCT03162341) was conducted among patients in the CRYSTALILLE inception cohort from a single tertiary-care rheumatology care clinic in France. Participants underwent DECT scans of both the knees and ankles/feet for suspected crystal-related arthropathy (both ankle and chronic diseases). Treatment-naive patients with gout initiating a treat-to-target urate-lowering therapy (ULT) received repeated DECT scans with concomitant measurements of serum urate levels at 6 and 12 months.
Among the 173 eligible patients in the cohort, 21 were excluded from the study because of knee replacement surgery. Of the remaining 152 individuals, 126 (82.9%) were diagnosed with gout; 26 participants without gout were included in the control group, of whom 15 (57.8%) had calcium pyrophosphate deposition disease. A total of 17 ULT-naive patients with gout were included in the follow-up study.
Results of the study showed that the prevalence of DECT-based vascular MSU-coded plaques was comparable among patients with gout (24.6%) and those without gout (23.1%; P =.87). Peripheral artery calcification severity scores were similar between patients with gout and control participants. A statistically significant strong association was found between vascular MSU-coded plaques and coexisting arterial calcification (P <.001), but not with soft-tissue MSU deposition.
Vascular MSU-coded plaques exhibited specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. Despite the use of effective ULT during the study follow-up, vascular MSU-coded plaques remained stable (P =.64), which was associated with significantly decreased serum urate levels and soft-tissue MSU volumes (P <.001).
Study limitations included the lack of histologic evidence to indicate the deposition of MSU crystals, the small size of the vascular MSU-coded plaques observed using DECT, and the relatively small sample size during follow-up.
Researchers concluded, “DECT findings suggestive of cardiovascular MSU deposition should be interpreted with caution and should not be a target when managing [patients with] gout.” They added, “Future studies should investigate whether these results in peripheral arteries could be generalized to vessels of other calibers and locations, particularly the coronary arteries and the aorta, bearing in mind additional technical considerations such as the need for electrocardiographic gating to avoid other types of DECT artifacts…”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Pascart T, Carpentier P, Choi HK, et al. Identification and characterization of peripheral vascular color-coded DECT lesions in gout and non-gout patients: the VASCURATE study. Semin Arthritis Rheum. 2021;51(4):895-902. doi:10.1016/j.semarthrit.2021.06.009