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Dr. Bharat Singh
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Rheumatologist & Clinical Immunologist
Rheumatologist & Clinical Immunologist

170 followers
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Gout Crystal Deposition is Deeper than its Measures

Dalbeth and colleagues have published that among gout patients without palpable tophic and despite long term allopurinol, nearly half have monosodium urate (MSU) as detected by Dual-energy CT (DECT). The total body urate deposition is even greater in those with higher sUA and evidence of severe disease.

They enrolled 152 gout patients from New Zealand and USA who were receiving allopurinol ≥300 mg/day for a mean of 5.1 years. MSU crystal deposition was assessed b DECT in the hands/wrists, feet/ankles/Achilles and knees and correlated with sUA levels and gout characteristics.

Among allopurinol treated patients, 69.1% had crystal deposition on DECT, with a median total crystal volume of 0.16 cm3.
Crystal deposition was found in 46.9% of patients with sUA <6.0 mg/dL and no palpable tophi
Crystal deposition was found in 90.0% among those with sUA ≥6.0 mg/dL and tophi.
Total volume of crystal deposition was positively associated with sUA ≥6.0 mg/dL, gout flares, tophi and the patients global disease activity scores.
These data are sobering, given the fact that only 30-45% of treated gouty patients will achieve a treat-to-target goal of sUA <6.0 mg/dl. Nearly half of the patients who achieve that goal in this cohort study still had tissue MSU crystal deposition.

Gout runs deeper than the tophi and is more sinister than the serum urate level measured.
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Weight loss is key for managing Gout
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Orthopedic collegues may have different opinion.
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Some thing came for dry eyes after a very long time. A new hope for this very disabiling and irritating conditions.
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Good Article: Biologics and Tuberculosis
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New update: Rituximab and TNF inhibitor Equivalence- A new hope for DMARD refractory patients.
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Cochrane Reports Moderate Evidence Favoring Biologic Add-on Therapy
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