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gout-pathogenesis-of-x-ray-findings

Gout: Pathogenesis of X-Ray findings Authors: Omer Mansoor, Nameerah Wajahat Reviewers: Reshma Sirajee, Tara Shannon *Stephanie Nguyen, *Shelley Spaner *MD at time of publication Hyperuricemia See hyperuricemia slide for mechanism ↑ Uric acid concentration in blood leaks into joints as monosodium urate (MSU) crystals Uric acid crystallizes due to lower temperature, change in pH, mechanical stress and other synovial factors Crystals found more commonly in 1st MTP joint > ankle > wrist MSU deposits within the bone producing intra-osseus tophi (stone-like deposits of crystals) MSU deposits in soft tissue and bone ↑ Inflammatory marker recruitment causes granulomatous inflammation Osteoclasts (↑ bone resorption) are activated, and osteoblasts (↑ bone formation) are inhibited at site of inflammation Marked localized bone loss ‘Rat Bite’ erosions Intra-osseus bone lesion (rare and non-specific for gout) Joint effusions may be seen on x-ray as an early finding in the acute phase of gout Soft Tissue Tophi (appear cloudy and can hide other x-ray findings) Normal bone density and preserved joint space (until late in the disease) Overhanging sclerotic margins Bone remodelled in an outward fashion to create the edge Punched out lytic bone lesions Appear as circular ‘hole punches’ in bone Note: Repeated episodes of gout must occur for 5 to 10 years before most joint changes may be seen on x-ray Image credit: Radiopaedia Legend: Pathophysiology Mechanism Sign/Radiographic Findings Complications Published June 7, 2022 on www.thecalgaryguide.com