Dual energy computed tomography for quantification of tissue urate deposits in tophaceous gout: help from modern physics in the management of an ancient disease.
Gout has been recognized for centuries but is also a modern day scourge. It is the most common type of inflammatory arthritis in men and appears to be increasing in both incidence and prevalence (Arromdee et al. in J Rheumatol 29(11):2403-2406, 2002). Despite these facts, few advances have been made in the diagnosis and treatment of gout for over 50 years. Difficult cases of gout challenge available therapeutic options. It is only recently that the Food and Drug Administration has approved febuxostat as a treatment option for patients intolerant of allopurinol. We describe a difficult case of tophaceous gout notable for several reasons: utilization of rasburicase as uricolytic treatment to dramatically reduce tissue urate burden; treatment of gout flares with interleukin-1β inhibition; and quantification of tissue urate with novel dual energy computed tomography technology before and after uricolytic therapy.
Bacani
A Kirstin
AK
Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.
McCollough
Cynthia H
CH
Glazebrook
Katrina N
KN
Bond
Jeffrey R
JR
Michet
Clement J
CJ
Milks
Jeffrey
J
Manek
Nisha J
NJ
D006073:Gout / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism; D006074:Gout Suppressants / Q000494:pharmacology / Q000627:therapeutic use; D050823:Hand Joints / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000494:pharmacology / Q000627:therapeutic use; D053583:Interleukin-1beta / Q000037:antagonists & inhibitors; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014503:Urate Oxidase / Q000494:pharmacology / Q000627:therapeutic use*; D014527:Uric Acid / Q000378:metabolism*; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000378:metabolism
D006074:Gout Suppressants; D053590:Interleukin 1 Receptor Antagonist Protein; D053583:Interleukin-1beta; C469709:rasburicase; D014527:Uric Acid; D014503:Urate Oxidase