Gout patients with negative dual-energy CTs generally have milder illness and lower comorbidities: Study
Dual-energy computed tomography (DECT) is used in the imaging of gouty arthritis. It has become increasingly widely used in recent years. DECT is a non-invasive method for visualizing, characterizing, and quantifying monosodium urate crystal deposits, aiding clinicians in early diagnosis, treatment, and follow-up of the condition.
Victor Laurent and colleagues, in their recent study, concluded that the correlation between the 0.1 cm3 threshold and clinical presentation and evolution was stronger than that of the 0.01 cm3 threshold. Gout patients with negative DECTs generally have milder symptoms and a lower burden of comorbidity. While they may not have particularly easy-to-treat hyperuricaemia, they may have a lower risk of flares.
This study is published in Rheumatology.
The study investigated the relationship between dual-energy CT (DECT) thresholds and MSU crystal deposition in gout patients starting urate-lowering therapy (ULT) and to determine which threshold is more clinically significant.
Researchers selected CRYSTALILLE cohort patients diagnosed with gout naïve to ULT with baseline DECT scans of the knees and feet. The study examined two thresholds for detecting MSU crystal deposition via DECT: <0.01 cm3 and <0.1 cm3. Baseline characteristics and the likelihood of achieving SU levels <6.0 and 5.0 mg/dl and experiencing flares at 6, 12, and 24 months were compared between patients with negative and positive DECT scans.
Key findings from the study are:
• 211 patients with a median age of 66.2 years with three years of median symptom duration were included in the study.
• 18 % and 43 % had negative DECT scans for the 0.01 and 0.1 cm3 thresholds, respectively.
• Younger age, shorter symptom duration and an absence of heart disease for both volume thresholds were factors associated with negative DECT scans.
• 23.1%, 11.5% and 5.6% of patients with <0.1 cm3 MSU crystals had flares at 6, 12 and 24 months, respectively, when compared with 40%, 25 % and 11.1% of patients with ≥0.1 cm3.
• 68.3% reached SU levels <6.0 mg/dl, and 48.9% reached levels <5.0 mg/dl, without any difference between positive and negative DECTs, with ULT dosages that tended to be lower in patients with negative DECTs.
In conclusion, the study results suggest that the 0.1 cm3 threshold correlates better with clinical presentation and evolution than the 0.01 cm3 threshold. Gout patients with negative DECTs generally have milder illness and lower comorbidities. They do not have particularly easy-to-treat hyperuricaemia but may have a lower risk of flare-ups.
Reference:
Victor Laurent et al. Are gout patients with negative dual-energy computed tomography for monosodium urate crystal deposition easy to treat? Rheumatology, 2024;, keae061, https://doi.org/10.1093/rheumatology/keae061
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