title: Usefulness of plain radiography for assessing hypouricemic treatment response in patients with tophaceous gout.
abstract: OBJECTIVE
  To investigate whether plain radiography is useful for assessing the changes in gouty tophi size following hypouricemic therapy.
  
  
  METHODS
  Gout was diagnosed according to the American College of Rheumatology criteria. Before and after hypouricemic treatment, serum uric acid level was measured, and plain radiography was performed to measure gouty tophi size. The tophi were graded by measuring the maximum vertical and horizontal diameters, and they were scored by adding up the scores of the grades. The vertical diameter was measured on both sides of the proximal phalanges (PPs). The horizontal diameter was measured on the lateral side of the PPs. The maximum vertical diameter measurement was graded 0-4. The maximum horizontal diameter measurement was graded 0-3.
  
  
  RESULTS
  Seven hundred first metatarsal phalangeal joints (MTPJ) of 350 patients with gout were assessed for gouty tophi. Tophi were observed using plain radiography in 174 MTPJs (24.9%) of 109 patients (31.1%). Follow-up plain radiography was performed in 60 of these patients. Before the treatment, the average serum uric acid level of these patients was 8.3 ± 1.9 mg/dL, and the average tophi score was 3.7 ± 2.5. After hypouricemic treatment, the uric acid level decreased to 5.9 ± 1.6 mg/dL (P < 0.05), and the average tophi score decreased to 1.5 ± 1.8 (P < 0.05).
  
  
  CONCLUSIONS
  This new method for measuring gouty tophi using plain radiography may be useful for evaluating changes in gouty tophi size following hypouricemic treatment.
authors: Department of Internal Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors: Young Sun
authors: YS
authors: Suh
authors: Department of Internal Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors: Yun-Hong
authors: YH
authors: Cheon
authors: Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea.
authors: Ji Eun
authors: JE
authors: Kim
authors: Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, Korea.
authors: Ji-Min
authors: JM
authors: Kim
authors: Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, Korea.
authors: Sang-Hyon
authors: SH
authors: Kim
authors: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
authors: Won-Seok
authors: WS
authors: Lee
authors: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
authors: Wan-Hee
authors: WH
authors: Yoo
authors: Department of Internal Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors: Sang-Il
authors: SI
authors: Lee
authors: Department of Internal Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors: Hyun-Ok
authors: HO
authors: Kim
mesh_terms: D000368:Aged; D001175:Arthrography; D015415:Biomarkers / Q000097:blood; D005260:Female; D006073:Gout / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006074:Gout Suppressants / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging* / Q000187:drug effects*; D008875:Middle Aged; D011237:Predictive Value of Tests; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D006074:Gout Suppressants; D014527:Uric Acid
keywords: X-rays; arthritis; gout; urate-lowering therapy; uric acid