ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
Ru
En

Usefulness of Different Imaging Techniques in Diagnosing Gout and Concomitant Calcium Pyrophosphate Deposition Disease

11 May 08:46

Study Objective: To assess the usefulness of X-ray, computed tomography (CT) and ultrasound (US) in the differential diagnosis of gout and concomitant calcium pyrophosphate deposition disease (CPDD).

Materials and Methods: Seventy-three patients (54 males and 19 females) were enrolled into a one-stage study. Group I included patients who had CPDD and gout (n = 22), Group II included patients who had calcium pyrophosphate crystals in the synovial fluid (n = 26) and Group III included patients with gout (n = 25). All patients had X-ray, CT and US of their knee joints.

Study Results: In patients who had calcium pyrophosphate crystals, chondrocalcinosis (CC) was detected in 54% by X-ray, in 73% by computed tomography and in 100% by US. In gout patients, X-ray helped detect intraosseous tophi in 32% of cases; CT showed intraosseous tophi and soft-tissue tophi in 92% and 80% of cases, respectively, and US revealed the double-contour sign, soft-tissue tophi and CC in 100%, 80% and 12%, respectively. In gout patients who had calcium pyrophosphate crystals in the synovial fluid, CC and the double-contour sign were detected by US in 100% of cases; soft-tissue tophi were revealed in 59% by US and in 50% by CT. In this patient population, CC was detected in 72% by X-ray and in 86% by CT; and intraosseous tophi were found in 27% by X-ray and in 72% by CT.

Conclusion: Ultrasound revealed the signs of both diseases — CC and the double-contour sign — in all patients who had sodium-monourate crystals and calcium pyrophosphate crystals in the synovial fluid. In Groups I and III, CT detected intraosseous tophi three times more often than X-ray. Moreover, in detecting soft-tissue tophi, CT was almost as effective as US.

S. A. Vladimirov — V. A. Nasonova Rheumatology Research Institute, Moscow. E-mail: ser_vlad@mail.ru

M. S. Eliseev — V. A. Nasonova Rheumatology Research Institute, Moscow. E-mail: elicmax@rambler.ru

L. A. Bozhieva — V. A. Nasonova Rheumatology Research Institute, Moscow. E-mail: doctor.ru@rusmg.ru

A. V. Smirnov — V. A. Nasonova Rheumatology Research Institute, Moscow. E-mail: doctor.ru@rusmg.ru

M. V. Severinova — V. A. Nasonova Rheumatology Research Institute, Moscow. E-mail: doctor.ru@rusmg.ru

A. V. Volkov — V. A. Nasonova Rheumatology Research Institute, Moscow. E-mail: doctor.ru@rusmg.ru

Доктор.ру
11 May 08:46
LITERATURE
  1. Барскова В. Г., Мукагова М. В., Северинова М. В., Елисеев М. С. и др. Диагностика подагры // Сиб. мед. журн. 2012. № 5. С. 132–135.
  2. Кудаева Ф. М., Владимиров С. А., Елисеев М. С., Волков А. В. и др. Особенности клинических проявлений болезни депонирования кристаллов пирофосфата кальция // Науч.-практ. ревматология. 2014. № 4. С. 405–409.
  3. Якунина И. А., Ильиных Е. В., Удельнова И. А., Барскова В. Г. и др. Частота выявления симптома «пробойника» при рентгенологическом исследовании дистальных отделов стоп больных с подагрой: связь с длительностью болезни и течением артрита // Науч.-практ. ревматология. 2003. № 2. С. 222–231.
  4. Backhaus M., Burmester G., Gerber T., Grassi W. et al. Guidelines for musculoskeletal ultrasound in rheumatology // Ann. Rheum. Dis. 2001. Vol. 60. N 7. P. 641–649.
  5. Bari C., Lapadula G., Cantatore P. Coexisting psoriatic arthritis, gout and chondrocalcinosis // Scand. J. Rheumatol. 1998. Vol. 27. N 4. P. 306–309.
  6. Barskova V. G., Kudaeva F. M., Bozhieva L. A., Smirnov A. V. et al. Comparison of three imaging techniques in diagnosis of chondrocalcinosis of the knees in Calcium Pyrophosphate Deposition Disease // Rheumatology Oxford. 2013. Vol. 52. N 6. P. 1090–1094.
  7. Brown A., Wakefield R., Schmidt W. Imaging // EULAR Compendium. 2009. P. 651–668.
  8. Eliseev M. S., Vladimirov S. A., Nasonov E. L. The frequency of calcium pyrophosphate deposition disease in patients with acute arthritis // Ann. Rheum. Dis. 2014. Vol. 73. Suppl. 2. P. S781–782.
  9. Filippou G., Frediani B., Gallo A., Menza L. et al. A “new” technique for the diagnosis of chondrocalcinosis of the knee: sensitivity and specificity of high-frequency ultrasonography // Ann. Rheum. Dis. 2007. Vol. 66. N 8. Р. 1126–1128.
  10. Frediani B., Filippou G., Falsetti P., Lorenzini S. et al. Diagnosis of calcium pyrophosphate dihydrate crystal deposition disease: ultrasonographic criteria proposed // Ann. Rheum. Dis. 2005. Vol. 64. N 4. P. 638–640.
  11. Genant H. Roentgenographic aspects of calcium pyrophosphate dihydrate crystal deposition disease (pseudogout) // Arthr. Rheum. 1976. Vol. 19. Suppl. 3. P. S307–328.
  12. Gerster J. C., Landry M., Dufresne L., Meuwly J. Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography // Ann. Rheum. Dis. 2002. Vol. 61. N 1. P. 52–54.
  13. Gerster J. C., Landry M., Duvoisin B., Rappoport G. Computed tomography of the knee joint as an indicator of intraarticular tophi in gout // Arthr. Rheum. 1996. Vol. 39. N 8. P. 1406–1409.
  14. Gerster J. C., Landry M., Rivier G. Computed tomographic imaging of subcutaneous gouty tophi // Clin. Rheumatol. 1998. Vol. 17. N 1. Р. 62–64.
  15. Gross B. D., Williams R. B., Di Cosimo C. J., Williams S. V. Gout and pseudogout of the temporomandibular joint // Oral Sur., Oral Med., Oral Pathol. 1987. N 63. Р. 551–554.
  16. Jones A., Chuck A., Arie E., Green D. et al. Diseases associated with calcium pyrophosphate deposition disease // Semin. Arthritis Rheum. 1992. Vol. 22. N 3. Р. 188–202.
  17. Kim Y. S., Kim H. S. Clinical images: bead-like gouty tophi in the hand and foot // Arthr. Rheum. 2010. Vol. 62. N 12. Р. 3624.
  18. Lothrenoo W., Sukitawut W. Calcium pyrophosphate dihydrate crystal deposition: a clinical and laboratory analysis of 91 Thai patients // J. Med. Assoc. Thai. 1999. Vol. 82. N 6. Р. 569–576.
  19. Martinez-Sanchis A., Pascual E. Intracellular and extracellular CPPD crystals are a regular feature in synovial fluid from uninflamed joints of patients with CPPD related arthropathy // Ann. Rheum. Dis. 2005. Vol. 64. N 12. P. 1769–1772.
  20. Paparo F., Fabbro E., Ferrero G., Piccazzo R. et al. Imaging studies of crystalline arthritidies // Reumatismo. 2012. Vol. 63. N 4. P. 263–275.
  21. Peh W. Tophaceous gout // Am. J. Orthop. 2001. Vol. 30. N 8. P. 665.
  22. Raikin S., Cohn B. T. Intraosseous gouty invasion of the talus // Foot Ancle Int. 1997. Vol. 18. N 7. P. 439–442.
  23. Robier C., Neubauer M., Quehenberger F., Rainer F. Coincidence of calcium pyrophosphate and monosodium urate crystals in the synovial fluid of patients with gout determined by cytocentrifugation technique // Ann. Rheum. Dis. 2011. Vol. 70. N 6. P. 1163–1164.
  24. Saliba I., Bouthiller A., Desrochers P., Berthlet F. et al. Tophaceous gout and pseudogout of the middle ear and the infratemporal fossa: case report and review of the literature // J. Otolaryngol. 2003. Vol. 32. N 4. P. 269–272.
  25. Stockman A., Darlington L., Scott J. Frequency of chondrocalcinosis of the knees and avascular necrosis of the femoral heads in gout: a controlled study // Ann. Rheum. Dis. 1980. Vol. 39. N 1. P. 7–11.
  26. Terkeltaub R. Gout and other crystal arthropathies. Philadelphia: Elsevier, 2012. P. 357.
  27. Zhang W., Doherty M., Pascual E., Bardin T. et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT) // Ann. Rheum. Dis. 2006. Vol. 65. N 10. P. 1301–1311.
  28. Zhang W., Neame R., Doherty S., Doherty M. Relative risk of knee chondrocalcinosis in siblings of index cases with pyrophosphate arthropathy // Ann. Rheum. Dis. 2004. Vol. 63. N 8. Р. 969–973.

News

30 June 00:00
A New Issue of Doctor.Ru Neurology Psychiatry, Vol. 20, No. 5 (2021), Published

Find original articles and reviews covering various aspects of neurology, psychiatry and the interview with Professor Marina Arkadievna Kinkulkina

28 June 00:00
A New Issue of Doctor.Ru Internal Medicine, Vol. 20, No. 4 (2021), Published

Find original articles and reviews covering various aspects of cardiology, gastroenterology, internal medicine and the interview with Professor Elena Zelikovna Golukhova

 

3 May 17:06
A New Issue of Doctor.Ru Pediatrics, Vol. 20, No. 3 (2021), Published

Find original articles and reviews covering various aspects of pediatrics and the interview with Professor Evgeny Grigorievich Furman

3 May 17:06
A New Issue of Doctor.Ru Endocrinology, Vol. 20, No. 2 (2021), Published

Find original articles and reviews covering various aspects of endocrinology and the interview with Professor Valentin Viktorovich Fadeev

16 April 11:57
Igor Evgenievich Khatkov joined the American Surgical Association

Igor Evgenievich Khatkov, Head of A. S. Loginov Moscow Clinical Scientific and Practical Centre, Chief Oncologist in and for Moscow is now an honoured member of the American Surgical Association.

All news