From the Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, USA; Rheumatology Section, NY Harbor Health Care System New York Campus, United States Department of Veterans Affairs, USA.
Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, USA.
Semin Arthritis Rheum. 2022 Oct;56:152064. doi: 10.1016/j.semarthrit.2022.152064. Epub 2022 Jun 30.
Gout is the most common cause of inflammatory arthritis in adults. Gout predominantly affects the peripheral joints, but an increasing number of published cases report gout affecting the spine. We used dual-energy CT (DECT) to assess the prevalence of monosodium urate (MSU) deposition in the spine of gout patients compared to controls, and to investigate whether gout or spinal MSU deposition is associated with low back pain.
25 controls and 50 gout subjects (non-tophaceous and tophaceous) were enrolled. Demographics, gout history, Aberdeen back pain score, serum urate (sU), ESR and CRP were ascertained. Subjects underwent DECT of the lumbosacral spine, which was analyzed using manufacturer's default post-processing algorithm for MSU deposition as well as a maximally-specific algorithm to exclude potential artifact.
72 subjects were analyzed (25 control, 47 gout). Gout subjects had greater BMI, serum creatinine, sU, CRP, and ESR versus controls. Using the default algorithm, MSU-coded volumes in the lumbosacral spines were significantly higher among the gout subjects vs controls (p = 0.018). 34% of gout subjects vs 4% of controls had spinal MSU-coded deposition (p = 0.0036). Applying the maximally-specific DECT post-processing algorithm, 18% of gout patients vs 0% of controls continued to demonstrate spinal MSU-coded deposition (p = 0.04). Non-tophaceous and tophaceous subjects did not differ in spinal MSU-coded deposition or sU. Gout patients had more back pain than controls.
A significant subpopulation of gout patients have spinal MSU-coded lesions. Default and maximally-specific MSU post-processing algorithms yielded different absolute MSU-coded volumes, but similar patterns of results. Gout patients had more back pain than controls. Spinal MSU deposition in gout patients may have implications for clinical picture and treatment.
痛风是成人中最常见的炎症性关节炎病因。痛风主要影响外周关节，但越来越多的已发表病例报告称痛风会影响脊柱。我们使用双能 CT（DECT）评估痛风患者与对照组相比，在脊柱中单钠尿酸盐（MSU）沉积的患病率，并研究痛风或脊柱 MSU 沉积是否与腰痛相关。
共纳入 25 名对照组和 50 名痛风患者（非痛风石性和痛风石性）。确定了人口统计学资料、痛风病史、阿伯丁腰痛评分、血清尿酸（sU）、红细胞沉降率（ESR）和 C 反应蛋白（CRP）。所有受试者均接受了腰骶部 DECT 检查，使用制造商默认的 MSU 沉积后处理算法以及最大特异性算法来排除潜在的伪影对 DECT 结果进行分析。
共分析了 72 名受试者（25 名对照组，47 名痛风组）。与对照组相比，痛风组患者的 BMI、血清肌酐、sU、CRP 和 ESR 更高。使用默认算法，痛风组腰骶部 MSU 编码容积显著高于对照组（p=0.018）。34%的痛风组患者与 4%的对照组存在脊柱 MSU 编码沉积（p=0.0036）。应用最大特异性 DECT 后处理算法，18%的痛风患者与 0%的对照组继续显示脊柱 MSU 编码沉积（p=0.04）。非痛风石性和痛风石性患者的脊柱 MSU 编码沉积或 sU 无差异。痛风患者的腰痛比对照组更常见。
痛风患者中有相当一部分存在脊柱 MSU 编码病变。默认和最大特异性 MSU 后处理算法得出的绝对 MSU 编码容积不同，但结果模式相似。痛风患者的腰痛比对照组更常见。痛风患者脊柱 MSU 沉积可能对临床表现和治疗有影响。
