title: Gout on CT of the feet: A symmetric arthropathy.
abstract: BACKGROUND
  The aim of this study was to assess the distribution of bone erosions in the feet of patients with gout using CT and thereby to test the hypothesis that gout is an asymmetric arthropathy.
  
  
  METHODS
  CT scans of both feet were obtained from 25 patients with chronic gout. CT scans were scored for bone erosion using a semi-quantitative method based on the rheumatoid arthritis MRI scoring system (RAMRIS). CT bone erosion was assessed at 22 bones in each foot (total 1,100 bones) by two independent radiologists. Symmetry was assessed by two methods: (i) comparing right and left foot scores for each patient; and (ii) calculating the proportion of paired joints with or without erosions.
  
  
  RESULTS
  Observer agreement was excellent (intra-class correlation coefficient 0.92). In the group overall, the difference in scores between the feet was not significant (Student's t-test P = 0.8). In 17 of 25 patients, the difference in erosion scores between the two feet was less than the inter-observer difference. In 24 of 25 patients, the proportion of paired joints was greater than 0.5, indicating symmetric disease.
  
  
  CONCLUSIONS
  Erosive disease from gout is, in fact, a symmetric process in our patient group. This finding is contrary to the established view of gout as an asymmetric arthritis and lends new insight into the behaviour of this common disease.
authors.affiliation: Radiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Doyle
authors.affiliation: Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.affiliation: Rheumatology and Molecular Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Fiona
authors.initials: F
authors.lastname: McQueen
authors.affiliation: Radiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Lucinda
authors.initials: L
authors.lastname: Boyer
authors.affiliation: Radiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Jing
authors.initials: J
authors.lastname: Dong
authors.affiliation: Department of Podiatry, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand.
authors.forename: Keith
authors.initials: K
authors.lastname: Rome
authors.affiliation: Department of Podiatry, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand.
authors.forename: Mike
authors.initials: M
authors.lastname: Frecklington
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015210:Arthritis, Gouty / Q000000981:diagnostic imaging*; D001175:Arthrography / Q000379:methods*; D005529:Foot Bones / Q000000981:diagnostic imaging*; D005534:Foot Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: musculoskeletal; musculoskeletal imaging