Gout x ray: Difference between revisions

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Latest revision as of 20:49, 24 September 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

X-ray findings of Gout varies depending on the type of episode. Acute attack of gout doesn't demonstrate any significant changes, while chronic gout may show subcortical swellings, intraarticular erosions and other findings, which are not significantly diagnostic for gout.

X-ray

Plain radiographs are often normal, although evidence of asymmetrical swelling and subcortical cysts without erosion may help to diagnose chronic gout.^[1]
Radiographic changes are a late feature of chronic gout, typically occurring after 15 years of disease onset, and is almost always present in patients with subcutaneous tophi.^[2]
Bone erosion is a feature of advanced gout and is characterized by a sclerotic rim and overhanging edge.^[3]
The joint space is usually preserved until late in the disease, and other features such as periosteal new bone formation, extra-articular erosions, intraosseous calcifications, joint space widening, and subchondral collapse may be present.^[4]

Patient #1

Patient #2

Sources

Copyleft images obtained courtesy of RadsWiki [2]

References

↑ Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, Gerster J, Jacobs J, Leeb B, Lioté F, McCarthy G, Netter P, Nuki G, Perez-Ruiz F, Pignone A, Pimentão J, Punzi L, Roddy E, Uhlig T, Zimmermann-Gòrska I (October 2006). "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. 65 (10): 1301–11. doi:10.1136/ard.2006.055251. PMC 1798330. PMID 16707533.
↑ Nakayama, Denny A.; Barthelemy, Carl; Carrera, Guillermo; Lightfoot, Robert W.; Wortmann, Robert L. (1984). "Tophaceous Gout: A Clinical and Radiographic Assessment". Arthritis & Rheumatism. 27 (4): 468–471. doi:10.1002/art.1780270417. ISSN 0004-3591.
↑ Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ (October 2015). "2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative". Ann. Rheum. Dis. 74 (10): 1789–98. doi:10.1136/annrheumdis-2015-208237. PMC 4602275. PMID 26359487.
↑ Resnick D, Broderick TW (December 1981). "Intraosseous calcifications in tophaceous gout". AJR Am J Roentgenol. 137 (6): 1157–61. doi:10.2214/ajr.137.6.1157. PMID 6976085.

Template:WH Template:WS

[pmid167075332-1] Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, Gerster J, Jacobs J, Leeb B, Lioté F, McCarthy G, Netter P, Nuki G, Perez-Ruiz F, Pignone A, Pimentão J, Punzi L, Roddy E, Uhlig T, Zimmermann-Gòrska I (October 2006). "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. 65 (10): 1301–11. doi:10.1136/ard.2006.055251. PMC 1798330. PMID 16707533.

[NakayamaBarthelemy1984-2] Nakayama, Denny A.; Barthelemy, Carl; Carrera, Guillermo; Lightfoot, Robert W.; Wortmann, Robert L. (1984). "Tophaceous Gout: A Clinical and Radiographic Assessment". Arthritis & Rheumatism. 27 (4): 468–471. doi:10.1002/art.1780270417. ISSN 0004-3591.

[pmid263594872-3] Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ (October 2015). "2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative". Ann. Rheum. Dis. 74 (10): 1789–98. doi:10.1136/annrheumdis-2015-208237. PMC 4602275. PMID 26359487.

[pmid6976085-4] Resnick D, Broderick TW (December 1981). "Intraosseous calcifications in tophaceous gout". AJR Am J Roentgenol. 137 (6): 1157–61. doi:10.2214/ajr.137.6.1157. PMID 6976085.

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@@ Line 5: / Line 5: @@
 Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
-==Overview==
+== Overview ==
-An x-ray is done when gout is suspected to rule out other abnormalities of the bone that may be causing the pain. Most commonly in gout, the x-ray will show no abnormalities, or a small amount of soft tissue swelling.
+X-ray findings of [[Gout]] varies depending on the type of episode. Acute attack of gout doesn't demonstrate any significant changes, while chronic gout may show subcortical swellings, intraarticular erosions and other findings, which are not significantly diagnostic for gout.
 ==X-ray==
-Plain film radiography may be used to evaluate gout; however, radiographic imaging findings generally do not appear until after at least 1 year of uncontrolled disease. The classic radiographic finding of gout late in disease is that  of  punched-out or rat-bite erosions with overhanging edges and sclerotic margins.          <sup>[[null 11]]</sup>
-Nuclear medicine studies can be used as a tool to measure the extent of gouty arthritis and to confirm clinically suspected disease. Characteristic findings include increased activity in the affected areas in all phases of a triple-phase bone scan.
+*Plain radiographs are often normal, although evidence of asymmetrical swelling and subcortical cysts without erosion may help to diagnose chronic gout.<ref name="pmid167075332">{{cite journal |vauthors=Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, Gerster J, Jacobs J, Leeb B, Lioté F, McCarthy G, Netter P, Nuki G, Perez-Ruiz F, Pignone A, Pimentão J, Punzi L, Roddy E, Uhlig T, Zimmermann-Gòrska I |title=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) |journal=Ann. Rheum. Dis. |volume=65 |issue=10 |pages=1301–11 |date=October 2006 |pmid=16707533 |pmc=1798330 |doi=10.1136/ard.2006.055251 |url=}}</ref>
+*Radiographic changes are a late feature of chronic gout, typically occurring after 15 years of disease onset, and is almost always present in patients with subcutaneous tophi.<ref name="NakayamaBarthelemy1984">{{cite journal|last1=Nakayama|first1=Denny A.|last2=Barthelemy|first2=Carl|last3=Carrera|first3=Guillermo|last4=Lightfoot|first4=Robert W.|last5=Wortmann|first5=Robert L.|title=Tophaceous Gout: A Clinical and Radiographic Assessment|journal=Arthritis & Rheumatism|volume=27|issue=4|year=1984|pages=468–471|issn=00043591|doi=10.1002/art.1780270417}}</ref>
-Ultrasonography for the diagnosis of gout has advantages in that it is easily available and portable and doesn't require ionizing radiation. However, its limitation include being unable to image deep structures or joint and is highly operator dependent.          <sup>[[null 11]]</sup>  Findings include the double-contour sign (hyperechoic irregular enhancement over the surface of the hyaline cartilage) and can identify tophus deposition in and around joints, erosions, and tissue inflammation if power Doppler US is used.          <sup>[[null 14], [null 15], [null 3], [null 13]]</sup>  According to the Agency for Healthcare Research and Quality (AHRQ), 4 ultrasound studies on gout showed sensitivities that ranged from 37-100% and specificities that ranged from 68-97%.          <sup>[[null 12]]</sup>
+*Bone erosion is a feature of advanced gout and is characterized by a sclerotic rim and overhanging edge.<ref name="pmid263594872">{{cite journal |vauthors=Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ |title=2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative |journal=Ann. Rheum. Dis. |volume=74 |issue=10 |pages=1789–98 |date=October 2015 |pmid=26359487 |pmc=4602275 |doi=10.1136/annrheumdis-2015-208237 |url=}}</ref>
+*The joint space is usually preserved until late in the disease, and other features such as periosteal new bone formation, extra-articular erosions, intraosseous calcifications, joint space widening, and subchondral collapse may be present.<ref name="pmid6976085">{{cite journal |vauthors=Resnick D, Broderick TW |title=Intraosseous calcifications in tophaceous gout |journal=AJR Am J Roentgenol |volume=137 |issue=6 |pages=1157–61 |date=December 1981 |pmid=6976085 |doi=10.2214/ajr.137.6.1157 |url=}}</ref>
-CT scanning can be used to study the effects of gout in areas that are hard to visualize with plain-film radiography. Many studies have been performed using dual-energy CT with good results,  providing visualization, characterization, and quantification of monosodium urate crystals.          <sup>[[null 16], [null 17], [null 18], [null 11], [null 19], [null 4]]</sup>  DECT scanners are able to perform simultaneous acquisitions at 80 and 140 kVp using two separate sets of x‐ray tubes and detectors positioned 90 to 95 degrees apart, thereby differentiating materials based on their relative absorption of x‐rays at the different photon energy levels.          <sup>[[null 11]]</sup>  According to the AHRQ, DECT has shown good sensitivity and specificity for predicting gout compared with synovial fluid analysis for monosodium urate crystals, with 3 studies showing sensitivities that ranged from 85-100% and specificities that ranged from 83-92%.
-The goal of joint X Ray is to rule out other diseases that affect the joint. The most common radiographic findings in patients with gout include soft-tissue swelling or an absence of abnormalities.
 '''Patient #1'''
 <gallery>
-Image:
+File:Gout-hand-001.jpg
+File:Gout-hand-002.jpg
-Gout-hand-001.jpg
+File:Gout-hand-003.jpg
+File:Gout-hand-004.jpg
-Image:
-Gout-hand-002.jpg
-Image:
-Gout-hand-003.jpg
-Image:
-Gout-hand-004.jpg
 </gallery>
 '''Patient #2'''
 <gallery>
-Image:
+File:Gout-101.jpg
+File:Gout-103.jpg
-Gout-101.jpg
+File:Gout-102.jpg
-Image:
-Gout-103.jpg
-Image:
-Gout-102.jpg
 </gallery>
 ==Sources==
@@ Line 59: / Line 34: @@
 ==References==
 {{Reflist|2}}
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 [[Category:Rheumatology]]
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