Monosodium Urate Measured With DECT Predicts Risk for Flare in Gout

Uric acid crystal
Uric acid crystal
The extent of monosodium urate burden measured with dual-energy computed tomography can predict the risk for disease flares in patients with gout.

In patients with gout, the extent of monosodium urate (MSU) burden measured with dual-energy computed tomography (DECT), but not with ultrasound, can predict the risk for disease flares, according to the results of a prospective, observational study published in Arthritis Research & Therapy.

The investigators sought to determine whether the degree of MSU burden assessed with DECT and ultrasound is predictive of an individual’s risk for gout flares. Patients with gout were recruited to undergo MSU burden evaluation with DECT and ultrasound scans of the feet and knees. Follow-up visits in all participants occurred at 3, 6, and 12 months. Patients who had presented with ≥1 flare at 6 months were compared with those who had not experienced any flares. Odds ratios (ORs) with respect to risk for flare were calculated.

A total of 78 patients were included in the study and underwent an initial assessment of urate burden using DECT and ultrasound scans. Overall, 64 patients attended ≥1 follow-up visit. According to bivariate analysis, the number of joints with the double contour sign was not significantly associated with the risk for flare (P =.67). Multivariate variable analysis showed that for every 1 cm3 increase in DECT volume in foot deposits, an individual’s risk for flare increased 2.03-fold during the first 6 months after initial evaluation (OR, 2.03; 95% CI, 1.15-4.38).

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The threshold volume that best differentiated those participants with and without gout flares was 0.81 cm3 (sensitivity, 61%; specificity, 77%).

The investigators noted that this is the first analysis to demonstrate that the extent of MSU burden in patients with gout measured with DECT, but not with ultrasound, can predict an individual’s risk for disease flares. Particular caution should be taken with respect to the prevention of flares in patients with gout who have an initial high urate burden.

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Pascart T, Grandjean A, Capon B, et al. Monosodium urate burden assessed with dual-energy computed tomography predicts the risk of flares in gout: a 12-month observational study: MSU burden and risk of gout flare. Arthritis Res Ther. 2018;20(1):210.