Urate crystal deposition and bone erosion in gout: ‘inside-out’ or ‘outside-in’? A dual-energy computed tomography study

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dc.contributor.author Towiwat, P en
dc.contributor.author Doyle, Anthony en
dc.contributor.author Gamble, Gregory en
dc.contributor.author Tan, P en
dc.contributor.author Aati, Opetaia en
dc.contributor.author Horne, Anne en
dc.contributor.author Stamp, LK en
dc.contributor.author Dalbeth, Nicola en
dc.date.accessioned 2016-11-13T23:26:47Z en
dc.date.issued 2016-12 en
dc.identifier.citation Arthritis Research and Therapy 18(1):Article number 208 Dec 2016 en
dc.identifier.issn 1478-6354 en
dc.identifier.uri http://hdl.handle.net/2292/31021 en
dc.description.abstract BACKGROUND: It is currently unknown whether bone erosion in gout occurs through an 'inside-out' mechanism due to direct intra-osseous crystal deposition or through an 'outside-in' mechanism from the surface of bone. The aim of this study was to examine the mechanism ('outside-in' vs. 'inside-out') of monosodium urate (MSU) crystal deposition in bone erosion in gout. Specifically, we used three-dimensional dual-energy computed tomography (DECT) to analyse the positional relationship between bone and MSU crystal deposition in tophaceous gout, and to determine whether intra-osseous crystal deposition occurs in the absence of erosion. METHODS: One hundred forty-four participants with gout and at least one palpable tophus had a DECT scan of both feet. Two readers independently scored all metatarsal heads (1433 bones available for scoring). For bones in contact with urate, the bone was scored for whether urate was present within an erosion, on the surface of bone or within bone only (true intra-osseous deposit). Data were analysed using generalised estimating equations. RESULTS: Urate in contact with bone was present in 370 (54.3 %) of 681 joints with urate deposition. For those bones in contact with urate, deposition was present on the surface of bone in 143 (38.6 %) of 370 joints and within erosion in 227 (61.4 %) of 370. True intra-osseous urate deposition was not observed at any site (p < 0.0001). For all bones with apparent intra-osseous deposition in one plane, examination in other planes revealed urate deposition within an en face erosion. CONCLUSIONS: In tophaceous gout, MSU crystal deposition is present within the joint, on the bone surface and within bone erosion, but it is not observed within bone in the absence of a cortical break. These data support the concept that MSU crystals deposit outside bone and contribute to bone erosion through an 'outside-in' mechanism. en
dc.publisher BioMed Central en
dc.relation.ispartofseries Arthritis Research and Therapy en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.sherpa.ac.uk/romeo/issn/1478-6354/ en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri https://creativecommons.org/licenses/by/2.0/ en
dc.title Urate crystal deposition and bone erosion in gout: ‘inside-out’ or ‘outside-in’? A dual-energy computed tomography study en
dc.type Journal Article en
dc.identifier.doi 10.1186/s13075-016-1105-z en
pubs.issue 1 en
pubs.volume 18 en
dc.description.version VoR - Version of Record en
dc.rights.holder Copyright: The authors en
dc.identifier.pmid 27629724 en
pubs.publication-status Published online en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.subtype Article en
pubs.elements-id 541311 en
pubs.org-id Medical and Health Sciences en
pubs.org-id Medical Sciences en
pubs.org-id Anatomy and Medical Imaging en
pubs.org-id School of Medicine en
pubs.org-id Medicine Department en
dc.identifier.eissn 1478-6362 en
pubs.number 208 en
pubs.record-created-at-source-date 2016-11-14 en
pubs.online-publication-date 2016-09-15 en
pubs.dimensions-id 27629724 en

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