title: Dual-Energy CT in Patients with Suspected Gouty Arthritis: Effects on Treatment Regimen and Clinical Outcome.
abstract: OBJECTIVE
  This investigation aimed to evaluate the impact on treatment regimen and clinical outcome of dual-energy computed tomography (DECT) in patients with suspected gouty arthritis.
  
  
  METHODS
  We retrospectively analyzed electronic medical records (EMR) of 39 patients (36 male, 3 female; age range, 36-85 years) who underwent DECT of peripheral joints because of suspected gouty arthritis. We assessed the prior medical history, lab results, treatment regimen, and medications before and after DECT, and changes in subjective severity of symptoms as stated by patients in the EMR. The presence of monosodium urate (MSU) crystals in the index joint was verified with DECT.
  
  
  RESULTS
  Several patients had a prior diagnosis of gout (n = 9), hyperuricemia (n = 6), rheumatoid arthritis (n = 3), or psoriatic arthritis (n = 3). Elevated uric acid blood levels were detected in 32 patients (82%) before DECT. On DECT, MSU crystals were detected in 23 patients (59%). Of the 36 cases, the current treatment regimen was modified after DECT to gout-specific therapy in 22 cases and other rheumatic diseases were targeted in 14 cases. Several medications were prescribed more frequently based after DECT compared to before DECT imaging, including steroids (n = 20 vs. n = 12, respectively), colchicine (n = 13 vs. n = 4, respectively), and urate-lowering medication (n = 18 vs. n = 11, respectively). A subjective reduction of clinical symptoms during cumulative follow-up was reported by 34 patients (87.2%).
  
  
  CONCLUSIONS
  Both positive and negative findings of MSU crystals on DECT have a significant impact on the treatment regimen and clinical outcome of patients with suspected gouty arthritis and facilitate differentiation from other rheumatic diseases.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Metzger
authors.affiliation: Department of Rheumatology, Clinic of the Goethe University, Frankfurt.
authors.forename: Michaela
authors.initials: M
authors.lastname: Koehm
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Department of Nephrology, Clinic of the Goethe University, Frankfurt.
authors.forename: Stefan
authors.initials: S
authors.lastname: Buettner
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Scholtz
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Beeres
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: J Matthias
authors.initials: JM
authors.lastname: Kerl
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: Moritz H
authors.initials: MH
authors.lastname: Albrecht
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Hammerstingl
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany. Electronic address: ralfwbauer@aol.com.
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Bauer
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015210:Arthritis, Gouty / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015535:Arthritis, Psoriatic / Q000175:diagnosis; D001172:Arthritis, Rheumatoid / Q000175:diagnosis; D003078:Colchicine / Q000627:therapeutic use; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006073:Gout / Q000175:diagnosis; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D033461:Hyperuricemia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood / Q000737:chemistry
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D014527:Uric Acid; D003078:Colchicine
keywords: Gout; corticosteroids; outcomes research; treatment