%0 Journal Article
%T Imaging Appearances in Gout
%A Gandikota Girish
%A David M. Melville
%A Gurjit S. Kaeley
%A Catherine J. Brandon
%A Janak R. Goyal
%A Jon A. Jacobson
%A David A. Jamadar
%J Arthritis
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/673401
%X Gout is an ancient disease. Last decade has brought about significant advancement in imaging technology and real scientific growth in the understanding of the pathophysiology of gout, leading to the availability of multiple effective noninvasive diagnostic imaging options for gout and treatment options fighting inflammation and controlling urate levels. Despite this, gout is still being sub-optimally treated, often by nonspecialists. Increased awareness of optimal treatment options and an increasing role of ultrasound and dual energy computed tomography (DECT) in the diagnosis and management of gout are expected to transform the management of gout and limit its morbidity. DECT gives an accurate assessment of the distribution of the deposited monosodium urate (MSU) crystals in gout and quantifies them. The presence of a combination of the ultrasound findings of an effusion, tophus, erosion and the double contour sign in conjunction with clinical presentation may be able to obviate the need for intervention and joint aspiration in a certain case population for the diagnosis of gout. The purpose of this paper is to review imaging appearances of gout and its clinical applications. 1. Introduction Gout is the most common cause of inflammatory arthritis in men [1] and its prevalence is rapidly expanding in the general population [2]. It is associated with an excess of uric acid in the body. This results in supersaturation of uric acid in body tissues and fluids resulting in urate deposition. Over 80% of the gout patients have a positive family history of gout or hyperuricemia. The disease is best understood as having four phases which include asymptomatic hyperuricemia, acute, intercritical, and chronic gout. The musculoskeletal manifestations of gout are triggered by the deposition of monosodium urate (MSU) crystals in cartilage, joints, and soft tissues. Acute gout attacks are due to the triggering of an inflammation pathway known as the NALP3 inflammasome by MSU crystals in the joint [3] and soft tissues. The diagnosis of gout is confirmed by the presence of intracellular MSU crystals in a joint aspirate [4]. MSU crystals are not radioopaque and are identified on polarized microscopy as negatively birefringent. Chronic gout can take years to develop and its findings include chronic synovitis, tophus formation, and erosions. Thus, the crystal induced tissue reaction in gout is different from other types of inflammatory arthritis where synovial inflammation is thought to be the predominant primary cause of tissue damage. An experienced clinician or a
%U http://www.hindawi.com/journals/arthritis/2013/673401/