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Gout
Eva M. Escobedo, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Synonyms

          • Gouty arthritis, tophaceous gout
        • Definitions

          • Hyperuricemia, resulting in monosodium urate (MSU) crystal deposition in soft tissues and joints
            • Primary gout: results from abnormalities in purine metabolism or from idiopathic ↓ renal excretion of urate
            • Secondary gout: results from ↑ serum uric acid levels resulting from associated disorders or precipitating factors
          • Tophus: chronic granulomatous lesion containing MSU crystals surrounded by inflammatory cells and connective tissue
          • Tophaceous gout largely extraarticular; intraarticular gout has different manifestations

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Abdellatif W et al: Unravelling the mysteries of gout by multimodality imaging. Semin Arthritis Rheum. 50(3S):S17-23, 2020
                                      2. Christiansen SN et al: Dual-energy CT in gout patients: do all colour-coded lesions actually represent monosodium urate crystals? Arthritis Res Ther. 22(1):212, 2020
                                      3. Filippucci E et al: Imaging of crystalline arthropathy in 2020. Best Pract Res Clin Rheumatol. 34(6):101595, 2020
                                      4. Singh JA et al: Gout epidemiology and comorbidities. Semin Arthritis Rheum. 50(3S):S11-6, 2020
                                      5. Cho SK et al: The prevalence of hyperuricemia sharply increases from the late menopausal transition stage in middle-aged women. J Clin Med. 8(3), 2019
                                      6. Davies J et al: Recent developments in advanced imaging in gout. Ther Adv Musculoskelet Dis. 11:1759720X19844429, 2019
                                      7. De Avila Fernandes E et al: Relevant aspects of imaging in the diagnosis and management of gout. Rev Bras Reumatol Engl Ed. 57(1):64-72, 2017
                                      8. Pattamapaspong N et al: Value of ultrasonography in the diagnosis of gout in patients presenting with acute arthritis. Skeletal Radiol. 46(6):759-67, 2017
                                      9. Mallinson PI et al: Dual-energy CT for the musculoskeletal system. Radiology. 281(3):690-707, 2016
                                      10. Chowalloor PV et al: Imaging in gout: a review of the recent developments. Ther Adv Musculoskelet Dis. 6(4):131-43, 2014
                                      11. Mallinson PI et al: Artifacts in dual-energy CT gout protocol: a review of 50 suspected cases with an artifact identification guide. AJR Am J Roentgenol. 203(1):W103-9, 2014
                                      12. Girish G et al: Advanced imaging in gout. AJR Am J Roentgenol. 201(3):515-25, 2013
                                      13. Lumezanu E et al: Axial (spinal) gout. Curr Rheumatol Rep. 14(2):161-4, 2012
                                      14. Desai MA et al: Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 31(5):1365-75; discussion 1376-7, 2011
                                      15. Glazebrook KN et al: Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 261(2):516-24, 2011
                                      16. Konatalapalli RM et al: Gout in the axial skeleton. J Rheumatol. 36(3):609-13, 2009
                                      17. Cammalleri L et al: Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci. 4(2):83-93, 2007
                                      18. Centers for Disease Control and Prevention (CDC): Projected state-specific increases in self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitations--United States, 2005-2030. MMWR Morb Mortal Wkly Rep. 56(17):423-5, 2007
                                      19. Choi HK et al: Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 57(1):109-15, 2007
                                      20. Keith MP et al: Updates in the management of gout. Am J Med. 120(3):221-4, 2007
                                      21. Pascual E et al: Therapeutic advances in gout. Curr Opin Rheumatol. 19(2):122-7, 2007
                                      22. Perez-Ruiz F et al: Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol. 19(2):128-33, 2007
                                      23. Reginato AM et al: Genetics and experimental models of crystal-induced arthritis. Lessons learned from mice and men: is it crystal clear? Curr Opin Rheumatol. 19(2):134-45, 2007
                                      24. Shah K et al: Does the presence of crystal arthritis rule out septic arthritis? J Emerg Med. 32(1):23-6, 2007
                                      25. Stamp LK et al: Emerging therapies in the long-term management of hyperuricaemia and gout. Intern Med J. 37(4):258-66, 2007
                                      26. Thiele RG et al: Diagnosis of gout by ultrasound. Rheumatology (Oxford). 46(7):1116-21, 2007
                                      27. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Synonyms

                                              • Gouty arthritis, tophaceous gout
                                            • Definitions

                                              • Hyperuricemia, resulting in monosodium urate (MSU) crystal deposition in soft tissues and joints
                                                • Primary gout: results from abnormalities in purine metabolism or from idiopathic ↓ renal excretion of urate
                                                • Secondary gout: results from ↑ serum uric acid levels resulting from associated disorders or precipitating factors
                                              • Tophus: chronic granulomatous lesion containing MSU crystals surrounded by inflammatory cells and connective tissue
                                              • Tophaceous gout largely extraarticular; intraarticular gout has different manifestations

                                            IMAGING

                                            • General Features

                                              • Imaging Recommendations

                                                • Radiographic Findings

                                                  • Ultrasonographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Abdellatif W et al: Unravelling the mysteries of gout by multimodality imaging. Semin Arthritis Rheum. 50(3S):S17-23, 2020
                                                                          2. Christiansen SN et al: Dual-energy CT in gout patients: do all colour-coded lesions actually represent monosodium urate crystals? Arthritis Res Ther. 22(1):212, 2020
                                                                          3. Filippucci E et al: Imaging of crystalline arthropathy in 2020. Best Pract Res Clin Rheumatol. 34(6):101595, 2020
                                                                          4. Singh JA et al: Gout epidemiology and comorbidities. Semin Arthritis Rheum. 50(3S):S11-6, 2020
                                                                          5. Cho SK et al: The prevalence of hyperuricemia sharply increases from the late menopausal transition stage in middle-aged women. J Clin Med. 8(3), 2019
                                                                          6. Davies J et al: Recent developments in advanced imaging in gout. Ther Adv Musculoskelet Dis. 11:1759720X19844429, 2019
                                                                          7. De Avila Fernandes E et al: Relevant aspects of imaging in the diagnosis and management of gout. Rev Bras Reumatol Engl Ed. 57(1):64-72, 2017
                                                                          8. Pattamapaspong N et al: Value of ultrasonography in the diagnosis of gout in patients presenting with acute arthritis. Skeletal Radiol. 46(6):759-67, 2017
                                                                          9. Mallinson PI et al: Dual-energy CT for the musculoskeletal system. Radiology. 281(3):690-707, 2016
                                                                          10. Chowalloor PV et al: Imaging in gout: a review of the recent developments. Ther Adv Musculoskelet Dis. 6(4):131-43, 2014
                                                                          11. Mallinson PI et al: Artifacts in dual-energy CT gout protocol: a review of 50 suspected cases with an artifact identification guide. AJR Am J Roentgenol. 203(1):W103-9, 2014
                                                                          12. Girish G et al: Advanced imaging in gout. AJR Am J Roentgenol. 201(3):515-25, 2013
                                                                          13. Lumezanu E et al: Axial (spinal) gout. Curr Rheumatol Rep. 14(2):161-4, 2012
                                                                          14. Desai MA et al: Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 31(5):1365-75; discussion 1376-7, 2011
                                                                          15. Glazebrook KN et al: Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 261(2):516-24, 2011
                                                                          16. Konatalapalli RM et al: Gout in the axial skeleton. J Rheumatol. 36(3):609-13, 2009
                                                                          17. Cammalleri L et al: Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci. 4(2):83-93, 2007
                                                                          18. Centers for Disease Control and Prevention (CDC): Projected state-specific increases in self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitations--United States, 2005-2030. MMWR Morb Mortal Wkly Rep. 56(17):423-5, 2007
                                                                          19. Choi HK et al: Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 57(1):109-15, 2007
                                                                          20. Keith MP et al: Updates in the management of gout. Am J Med. 120(3):221-4, 2007
                                                                          21. Pascual E et al: Therapeutic advances in gout. Curr Opin Rheumatol. 19(2):122-7, 2007
                                                                          22. Perez-Ruiz F et al: Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol. 19(2):128-33, 2007
                                                                          23. Reginato AM et al: Genetics and experimental models of crystal-induced arthritis. Lessons learned from mice and men: is it crystal clear? Curr Opin Rheumatol. 19(2):134-45, 2007
                                                                          24. Shah K et al: Does the presence of crystal arthritis rule out septic arthritis? J Emerg Med. 32(1):23-6, 2007
                                                                          25. Stamp LK et al: Emerging therapies in the long-term management of hyperuricaemia and gout. Intern Med J. 37(4):258-66, 2007
                                                                          26. Thiele RG et al: Diagnosis of gout by ultrasound. Rheumatology (Oxford). 46(7):1116-21, 2007
                                                                          27. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007