title: Factors associated with change in radiographic damage scores in gout: a prospective observational study.
abstract: OBJECTIVE
  Radiographic damage is frequently observed in patients with longstanding gout. The aim of this prospective observational study was to determine factors associated with change in radiographic damage scores in gout.
  
  
  METHODS
  People with gout and disease duration <10 years were recruited into this prospective observational study. At the baseline visit, structured assessment was undertaken in 290 participants including detailed clinical examination and plain radiographs (XR) of the hands and feet. Participants were invited to attend a further study visit with repeat XR 3 years after the baseline visit. XR were scored for erosion and joint space narrowing according to the gout-modified Sharp/van der Heijde XR damage score.
  
  
  RESULTS
  Age, subcutaneous tophus count and tender joint count were independently associated with XR damage score at the baseline visit. Paired serial XR were available for 140 participants. In stepwise linear regression analysis, change in total damage score over 3 years was positively associated with change in subcutaneous tophus count and baseline XR damage score, and inversely associated with baseline subcutaneous tophus count (model R2=0.39, p<0.001). Change in subcutaneous tophus count contributed most to the change in erosion score (partial R2change=0.31, p<0.001), and baseline XR damage score contributed most to the change in narrowing score (partial R2change=0.31, p<0.001).
  
  
  CONCLUSIONS
  Development of new subcutaneous tophi and baseline radiographic damage are associated with progressive joint damage scores in people with gout. These data provide further evidence that the tophus plays a central role in bone erosion in gout.
authors.affiliation: Department of Radiology, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Alastair
authors.initials: A
authors.lastname: Eason
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Meaghan E
authors.initials: ME
authors.lastname: House
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Vincent
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Julie
authors.initials: J
authors.lastname: Knight
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Paul
authors.initials: P
authors.lastname: Tan
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Anne
authors.initials: A
authors.lastname: Horne
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gamble
authors.affiliation: Radiology with Anatomy, University of Auckland, Auckland, New Zealand.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Doyle
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: William J
authors.initials: WJ
authors.lastname: Taylor
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018450:Disease Progression; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging; D006073:Gout / Q000000981:diagnostic imaging* / Q000473:pathology*; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography / Q000379:methods; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Arthritis; Chondrocytes; Gout