Monosodium urate burden assessed with dual-energy computed tomography predicts the risk of flares in gout: a 12-month observational study : MSU burden and risk of gout flare

Tristan Pascart, Agathe Grandjean, Benoist Capon, Julie Legrand, Nasser Namane, Vincent Ducoulombier, Marguerite Motte, Marie Vandecandelaere, Hélène Luraschi, Catherine Godart, Eric Houvenagel, Laurène Norberciak, Jean-François Budzik, Tristan Pascart, Agathe Grandjean, Benoist Capon, Julie Legrand, Nasser Namane, Vincent Ducoulombier, Marguerite Motte, Marie Vandecandelaere, Hélène Luraschi, Catherine Godart, Eric Houvenagel, Laurène Norberciak, Jean-François Budzik

Abstract

Background: Predicting the risk of flares in patients with gout is a challenge and the link between urate burden and the risk of gout flare is unclear. The objective of this study was to determine if the extent of monosodium urate (MSU) burden measured with dual-energy computed tomography (DECT) and ultrasonography (US) is predictive of the risk of gout flares.

Methods: This prospective observational study recruited patients with gout to undergo MSU burden assessment with DECT (volume of deposits) and US (double contour sign) scans of the knees and feet. Patients attended follow-up visits at 3, 6 and 12 months. Patients having presented with at least one flare at 6 months were compared to those who did not flare. Odds ratios (ORs) (95% confidence interval) for the risk of flare were calculated.

Results: Overall, 64/78 patients included attended at least one follow-up visit. In bivariate analysis, the number of joints with the double contour sign was not associated with the risk of flare (p = 0.67). Multivariate analysis retained a unique variable: DECT MSU volume of the feet. For each 1 cm3 increase in DECT MSU volume in foot deposits, the risk of flare increased 2.03-fold during the first 6 months after initial assessment (OR 2.03 (1.15-4.38)). The threshold volume best discriminating patients with and without flare was 0.81 cm3 (specificity 61%, sensitivity 77%).

Conclusions: This is the first study showing that the extent of MSU burden measured with DECT but not US is predictive of the risk of flares.

Keywords: Dual-energy computed tomography; Flares; Gout; Ultrasonography.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for the study was received from the Institutional Medical Ethics Review Board of the Lille Catholic Hospitals (reference number 2016-04-06). All patients provided informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
ROC curve explaining the risk of presenting with at least one flare during the first 6 months of follow up, with the monosodium urate volume deposited in the feet measured with dual-energy computed tomography. The red dot indicates the volume providing the best discrimination between the group of patients presenting with at least one flare and those without flare. The associated predictive values for this volume are shown. AUC, area under the curve; Sp, specificity; Se, sensitivity
Fig. 2
Fig. 2
Dual-energy computed tomography imaging of monosodium urate crystal deposition in the feet. Small (volume 0.17 cm3) (a), large (volume 5.29 cm3) (b) and cutoff (c) soft tissue volume of deposits in patients with flare and without flare (volume 0.81 cm3)

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