scholarly journals Urate in fingernail represents the deposition of urate burden in gout patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Haibing Chen ◽  
Lili Zhao ◽  
Fengjing Liu ◽  
Si Chen ◽  
Zhumeng Hu ◽  
...  
Keyword(s):  
High Performance ◽  
Dual Energy ◽  
The Body ◽  
Dual Energy Ct ◽  
Monosodium Urate ◽  
Non Invasive ◽  
Follow Up Study ◽  
Lowering Therapy ◽  
Msu Crystals

Abstract Urate in the fingernails of gout patients and healthy volunteers was successfully detected by high-performance liquid chromatography (HPLC) with ultraviolet (UV) in our previous research. This study aimed to further investigate whether nail urate could be a proxy for the burden of monosodium urate (MSU) crystals deposits in gout. To this end, we conducted a study in two parts. Firstly, we successfully detected urate in the nail by HPLC–UV and evaluated nail urate concentrations in control subjects and patients with gout. As expected, we found that levels of nail urate were significantly higher in patients with gout than in healthy controls, and the nail urate level was significantly correlated with the volume of MSU crystals deposits measured by dual-energy CT (DECT). Secondly, we found that nail urate can reflect changes in urate levels in the body during urate lowering therapy through a 3-month follow-up study. Our results provide the possibility of quantification of urate in human fingernails as a non-invasive alternative for assessing MSU crystals deposits in gout.

scholarly journals AB0926 PERFORMANCE OF THE ACR-EULAR GOUT CLASSIFICATION CRITERIA FOR THE DIAGNOSIS GOUT IN CLINICAL PRACTICE: A ONE-YEAR FOLLOW-UP STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1763.1-1764
Author(s):  
M. Gamala ◽  
J. W. G. Jacobs ◽  
S. Linn-Rasker ◽  
M. Nix ◽  
B. Heggelman ◽  
...  
Keyword(s):  
Uric Acid ◽  
Clinical Practice ◽  
Serum Uric Acid ◽  
Dual Energy ◽  
Classification Criteria ◽  
Dual Energy Ct ◽  
Research Support ◽  
Follow Up Study ◽  
One Year

Background:Classification criteria are used for classifying groups of patients, especially for clinical trials, and diagnostic criteria for diagnosis in individual patients.Objectives:to establish the performance of the 2015 ACR/EULAR gout classification criteria for the diagnosis gout in patients with undifferentiated arthritis. Secondary, to explore the use and efficacy of uric acid lowering therapy (ULT) in daily clinical practice in new gout patients.Methods:1-year follow-up study was performed in subjects with unclassified arthritis, who had been classified as gout patients or not, according the gout classification criteria, including imaging with dual-energy CT, but without ultrasonography and joint X-rays.(1) The reference was the clinical diagnosis (gout yes/no) after 1-year follow-up.Results:71 patients were included; their demographic and clinical characteristics are summarized in Table 1. All 63/71 patients classified as having gout at baseline also had a clinical gout diagnosis after one year, and of the patients not classified, none had the clinical diagnosis of gout at one year.Table 1.Characteristics of the 71subjects included in analysesDiagnosis**gout (n=63)no gout (n=8)Age in years, mean (SD)62 (14)59 (14)Male gender, N (%)53 (84)5 (63)Symptom duration* at baseline in months, median (IQR)12 (1-48)8 (0.5-33)Joint involvement at baseline N patients (%):MTP,33 (52)1 (12)ankle/midfoot12 (19)1 (12)other joint18 (29)6 (76)SUA intercritical in umol/l, mean (SD)484 (63)337 (71)2015 ACR/EULAR criteria baseline score, mean (SD)***10.3 (2.5)2.6 (1.5)2015 ACR/EULAR criteria ≥8 points, N patients (%)***57 (90)0 (0)MSU crystal positive joint aspiration, N patients (%)44 (70)0 (0)DECT positive, N patients (%)49 (78)0 (0)* self-reported, intermittent symptoms; ** all patients classified with gout at baseline also had a clinical gout diagnosis after one yea; *** using a somewhat limited set, see methodsMTP, metatarsophalangeal joints; SUA, serum uric acid; DECT, dual-energy CT; MSU, monosodium urate;.Sensitivity, specificity, positive and negative predictive value, and accuracy values (95% CI) of the classification criteria set we used were 0.91 (0.80-0.96); 1 (0.63-1); 1; 0.57 (0.38-0.74) and 0.92 (0.83-0.97), respectively. The area under the receiver operating characteristics curve (95% CI) was 0.95 (0.91-0.99).ULT was started in 49/63 (78%) of gout patients; 45/49 (92%) of them had serum uric acid levels ≤ 360 μmol/l and no recurrent gout attack during one-year follow-up.Conclusion:The 2015 ACR-EULAR gout classification criteria performed well for the diagnosis gout in clinical practice. Most gout patients had been treated successfully, according to current guidelines.References:[1]Gamala M, Jacobs JWG, Linn-Rasker SF, Nix M, Heggelman BGF, Pasker-de Jong PCM, et al. The performance of dual-energy CT in the classification criteria of gout: a prospective study in subjects with unclassified arthritis. Rheumatology 2019 Sep (Epub ahead print).Disclosure of Interests:Mihaela Gamala: None declared, Johannes W. G. Jacobs Grant/research support from: Roche, Suzanne Linn-Rasker: None declared, Maarten Nix: None declared, Ben Heggelman: None declared, Pieternel Pasker: None declared, Jacob M. van Laar Grant/research support from: MSD, Genentech, Consultant of: MSD, Roche, Pfizer, Eli Lilly, BMS, Ruth Klaasen: None declared

scholarly journals OP0175 IDENTIFYING PERIPHERAL VASCULAR MONOSODIUM URATE CRYSTAL DEPOSITION WITH DUAL-ENERGY CT: FACT OR FICTION? THE VASCURATE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 109.2-109
Author(s):  
T. Pascart ◽  
P. Carpentier ◽  
L. Norberciak ◽  
J. Legrand ◽  
E. Houvenagel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Longitudinal Study ◽  
Soft Tissues ◽  
Dual Energy ◽  
Monosodium Urate ◽  
Peripheral Vascular ◽  
Crystal Deposition ◽  
Lowering Therapy ◽  
Crystal Volume

Background:The close relationship between gout and cardiovascular diseases is well established. A growing hypothesis explaining this association would be that monosodium urate (MSU) crystals are deposited within vessel walls. Dual-energy computed tomography (DECT) can identify and quantify MSU crystal deposition in soft tissues. It remains unclear whether vascular spots exhibiting DECT attenuation characteristics of MSU are artefacts or true MSU crystal deposits.Objectives:The objectives of this study were to determine whether the presence of peripheral vascular MSU crystal deposition identified with DECT is associated with the extent of MSU deposits in joint soft tissues, and if this association persists over time under urate-lowering therapy.Methods:Patients with a clinical suspicion or established gout diagnosis prospectively underwent DECT for identification and quantification of the MSU crystal burden in their knees and feet. Some of these patients were also enrolled in the GOUT-DECTUS longitudinal study, and thus underwent follow-up DECT scans of their knees and feet at 6, 12 and 24 months. DECT scans were examined for the presence of vascular spots ≥0.01 cm3 classified as MSU crystal deposits according to the default post-processing settings. Multiple linear regressions adjusting on serum urate levels and gout diagnosis were implemented to determine the association between DECT MSU crystal volume in joint soft tissues, and the presence of vascular MSU deposits. Mixed linear models were used to compare DECT volumes of MSU crystal deposition in soft tissues between vascular MSU positive and negative patients during follow-up.Results:A total of 169 patients were included, of which 140 had a final diagnosis of gout, including 15 also included in the longitudinal study. Patients were mostly male (78.8%) and were 65.5 ± 14.6 years old. Among gout patients, disease duration was 9.3 ± 9.9 years and 56.5% were urate lowering therapy-naive. A total of 11/29 (37.9%) controls and 40/140 (28.6%) gout patients presented with a least one vascular spot of DECT MSU deposition, with an average volume of 0.02 ± 0.02 cm3, and all subjects also presented at least one vascular calcification. In the feet, patients positive for vascular DECT MSU crystal deposition had an MSU volume of 3.81 ± 10.06 cm3 in joint soft tissues, compared with 1.85 ± 7.72 cm3 for those without vascular MSU deposition (p=0.018). In the knees, patients with vascular MSU deposition had an MSU crystal volume of 6.03 ± 24.13 cm3 in joint soft tissues, compared with 0.83 ± 2.88 cm3 for those without vascular evidence of MSU deposition. In the longitudinal subgroup analysis, coefficients of the fixed effects for the presence of vascular MSU deposits on the MSU crystal volume in joint soft tissues was 0.4 (p=0.35) in the feet and 1.21 (p=0.03) in the knees. The presence of vascular DECT MSU deposits was associated with a 3.4-fold increase in MSU crystal volume in knee joint soft tissues throughout follow-up.Conclusion:This study suggests that some vascular spots identified with DECT as MSU crystal deposition may be real and not artefacts. This correlation remains throughout follow-up in the knees. However, the comparable prevalence of vascular DECT MSU deposits between gout patients and controls, the systematic co-existence of vascular calcifications and the uneven regression under urate-lowering therapy requires further analysis to determine which DECT spots are artefacts and which are not.References:[1]Dual-Energy Computed Tomography Detection of Cardiovascular Monosodium Urate Deposits in Patients With Gout. Klauser AS, Halpern EJ, Strobl S, Gruber J, Feuchtner G, Bellmann-Weiler R, Weiss G, Stofferin H, Jaschke W.Disclosure of Interests:Tristan Pascart Grant/research support from: Research Grant Horizon Pharma, Consultant of: Novartis, BMS, Sanofi, Pfizer,, Speakers bureau: Novartis, BMS, Paul Carpentier: None declared, Laurène Norberciak: None declared, Julie Legrand: None declared, Eric Houvenagel Speakers bureau: Janssen, Novartis, Fabio Becce: None declared, Jean-François Budzik: None declared

scholarly journals Dual-energy CT in gout patients: Do all colour-coded lesions actually represent monosodium urate crystals?

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Sara Nysom Christiansen ◽  
Felix Christoph Müller ◽  
Mikkel Østergaard ◽  
Ole Slot ◽  
Jakob M. Møller ◽  
...  
Keyword(s):  
Effective Atomic Number ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Similar Distribution ◽  
Monosodium Urate ◽  
Hounsfield Units ◽  
Post Hoc ◽  
Similar Distribution Pattern ◽  
Msu Crystals ◽  
Urate Crystals

Abstract Background Dual-energy CT (DECT) can acknowledge differences in tissue compositions and can colour-code tissues with specific features including monosodium urate (MSU) crystals. However, when evaluating gout patients, DECT frequently colour-codes material not truly representing MSU crystals and this might lead to misinterpretations. The characteristics of and variations in properties of colour-coded DECT lesions in gout patients have not yet been systematically investigated. The objective of this study was to evaluate the properties and locations of colour-coded DECT lesions in gout patients. Methods DECT of the hands, knees and feet were performed in patients with suspected gout using factory default gout settings, and colour-coded DECT lesions were registered. For each lesion, properties [mean density (mean of Hounsfield Units (HU) at 80 kV and Sn150kV), mean DECT ratio and size] and location were determined. Subgroup analysis was performed post hoc evaluating differences in locations of lesions when divided into definite MSU depositions and possibly other lesions. Results In total, 4033 lesions were registered in 27 patients (23 gout patients, 3918 lesions; 4 non-gout patients, 115 lesions). In gout patients, lesions had a median density of 160.6 HU and median size of 6 voxels, and DECT ratios showed an approximated normal distribution (mean 1.06, SD 0.10), but with a right heavy tail consistent with the presence of smaller amounts of high effective atomic number lesions (e.g. calcium-containing lesions). The most common locations of lesions were 1st metatarsophalangeal (MTP1), knee and midtarsal joints along with quadriceps and patella tendons. Subgroup analyses showed that definite MSU depositions (large volume, low DECT ratio, high density) had a similar distribution pattern, whereas possible calcium-containing material (high DECT ratio) and non-gout MSU-imitating lesions (properties as definite MSU depositions in non-gout patients) were primarily found in some larger joints (knee, midtarsal and talocrural) and tendons (Achilles and quadriceps). MTP1 joints and patella tendons showed only definite MSU depositions. Conclusion Colour-coded DECT lesions in gout patients showed heterogeneity in properties and distribution. MTP1 joints and patella tendons exclusively showed definite MSU depositions. Hence, a sole focus on these regions in the evaluation of gout patients may improve the specificity of DECT scans.

Non-invasive assessment of cirrhosis using multiphasic dual-energy CT iodine maps: correlation with model for end-stage liver disease score

2020 ◽  
Author(s):  
Domenico Mastrodicasa ◽  
Martin J. Willemink ◽  
Celina Duran ◽  
Andrea Delli Pizzi ◽  
Virginia Hinostroza ◽  
...  
Keyword(s):  
Liver Disease ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Disease Score ◽  
Non Invasive ◽  
End Stage Liver Disease ◽  
End Stage ◽  
Iodine Maps

scholarly journals Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Elin Svensson ◽  
Ylva Aurell ◽  
Lennart T. H. Jacobsson ◽  
Anton Landgren ◽  
Valgerdur Sigurdardottir ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Dual Energy ◽  
University Hospital ◽  
Dual Energy Ct ◽  
Kappa Statistics ◽  
Monosodium Urate ◽  
Beam Hardening ◽  
Monosodium Urate Crystals ◽  
Scintillator Detector ◽  
Urate Crystals

Abstract Background A definite diagnosis of gout requires demonstration of monosodium urate crystals in synovial fluid or in tophi, which in clinical practice today seldom is done. Dual energy CT (DECT) has repeatedly been shown to be able to detect monosodium urate crystals in tissues, hence being an alternative method to synovial fluid microscopy. The vast majority of these studies were performed with CT scanners with two X-ray tubes. In the present study we aim to investigate if and at what locations DECT with rapid kilovoltage-switching source with gemstone scintillator detector (GSI) can identify MSU crystals in patients with clinically diagnosed gout. We also performed a reliability study between two independent readings. Methods Patients with new or established gout who had been examined with DECT GSI scanning of the feet at Sahlgrenska University Hospital, Mölndal between 2015 and 2018 were identified. Their medical records were sought for gout disease characteristics using a structured protocol. Urate deposits in MTP1, MTP 2–5, ankle/midfoot joints and tendons were scored semiquantatively in both feet and presence of artifacts in nail and skin as well as beam hardening and noise were recorded. Two radiologists performed two combined readings and scoring of the images, thus consensus was reached over the scoring at each occasion (Espeland et al., BMC Med Imaging. 2013;13:4). The two readings were compared with kappa statistics. Results DECT GSI could identify urate deposits in the feet of all 55 participants with gout. Deposits were identified in the MTP-joints of all subjects but were also present in ankle/midfoot joints and tendons in 96 and 75% respectively. Deposition of urate was predicted by longer disease duration (Spearman’s Rho 0.64, p < .0001) and presence of tophi (p = 0.0005). Artifacts were common and mostly found in the nails (73%), a minority displayed skin artifacts (31%) while beam hardening and noise was rare. The agreement between the two readings was good (Κ = 0.66, 95% CI = 0.61–0.71). Conclusion The validity of DECT GSI in gout is supported by the identification of urate in all patients with clinical gout and the good correlations with clinical characteristics. The occurrence of artifacts was relatively low with expected locations.

scholarly journals Peer-to-peer learning through research: a case study in delivering a healthcare message

2016 ◽  
Author(s):  
Sadaf Ilias ◽  
Jill Barber
Keyword(s):  
Antibiotic Resistance ◽  
Undergraduate Students ◽  
The Body ◽  
The Other ◽  
Learning Activity ◽  
Follow Up Study ◽  
Raising Awareness ◽  
Second Year

This case study describes a recent learning activity involving pharmacy undergraduate students in which a final (fourth) year student trained 21 second year students to administer questionnaires about antibiotic resistance to over 700 student users of a large university building. The aim was to raise awareness of the problem of antibiotic resistance.  The second year students were also trained to correct any misapprehensions held by the questionnaire participants about antibiotic resistance, and to encourage them to become "Antibiotic Guardians". Finally the 22 students analysed the data to give a picture of what the other students understood about antibiotic resistance.  Peer-assisted learning therefore cascaded from a single fourth year student to 21 second year students and then to 700 students from various disciplines and year groups.  The first stage of the cascade was evaluated and the 21 second year students overwhelmingly believed that their knowledge of antibiotic resistance was enhanced.  A follow-up study using the same questionnaire will be used to determine whether the exercise was effective in raising awareness of antibiotic resistance among the body of students surveyed.

Imaging in gout

2016 ◽  
Author(s):  
Nicola Dalbeth
Keyword(s):  
Gold Standard ◽  
Serum Urate ◽  
Effective Management ◽  
Monosodium Urate ◽  
Spot Urine ◽  
Blood Tests ◽  
Lowering Therapy ◽  
Msu Crystals ◽  
Important Test ◽  
Morbid Conditions

Identification of monosodium urate (MSU) crystals is the gold standard for gout diagnosis. Serum urate is an important test for both gout diagnosis and effective management. For all people with gout on urate-lowering therapy, the target urate concentration is less than 0.36 mmol/L (6 mg/dL). Blood tests may also assist with screening for co-morbid conditions in gout. Spot urine tests may assist in determining the basis for hyperuricaemia in people with gout. Microscopically, the tophus represents a chronic inflammatory granulomatous response to MSU crystal aggregates.

Cerebral contrast staining mimicking parenchymal haemorrhage in a stroke patient

2020 ◽  
Vol 13 (12) ◽  
pp. e236400
Author(s):  
Elvin Yuan Ting Lim ◽  
Saravana Kumar Swaminathan
Keyword(s):  
Ct Scan ◽  
Middle Cerebral Artery ◽  
Signs And Symptoms ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Iodinated Contrast ◽  
Acute Infarct ◽  
The Right ◽  
The Brain

A 75-year-old female patient presented with signs and symptoms of a right hemispheric syndrome. A CT scan of the brain with angiogram showed an acute infarct in the right middle cerebral artery (MCA) territory secondary to thromb-occlusion of the M1 segment of the right MCA. A follow-up CT scan 2 weeks later showed a large hyperdense region in the infarcted area. With the aid of a dual-energy CT scan, this was eventually shown to be due to contrast staining from an earlier administration of iodinated contrast on the same day, rather than frank haemorrhagic conversion of the recent right MCA infarct.

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