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Case ReportImages in Rheumatology

Two Cases of Gouty Sacroiliitis Evaluated by Dual-energy Computed Tomography

TOMOKA AO, HIROFUMI SHODA and KAZUHIKO YAMAMOTO
The Journal of Rheumatology June 2016, 43 (6) 1146-1147; DOI: https://doi.org/10.3899/jrheum.151454
TOMOKA AO
Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo;
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HIROFUMI SHODA
Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo;
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  • For correspondence: shoda-tky@umin.ac.jp
KAZUHIKO YAMAMOTO
Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Dual-energy computed tomography (DECT) is a method to detect urate crystals in gouty joints. DECT uses 2 separate radiography tubes producing differing energy levels, which allows an identification of urate crystals in articular and periarticular locations1. The usefulness of DECT has been reported for a diagnosis of gouty spondyloarthritis2,3. We report 2 cases of gouty sacroiliitis evaluated by DECT.

Case 1

A 44-year-old man was admitted because of multiple peripheral joint swelling, tophus, and tenderness in his sacroiliac joints (SIJ). He had a 14-year history of gout, and an 8-year history of inflammatory back pain. Laboratory tests showed elevated C-reactive protein (CRP; 14.26 mg/dl) and hyperuricemia (9.9 mg/dl). His HLA-B27 was positive. A joint fluid aspiration from ankles contained urate crystals. Magnetic resonance imaging (MRI) showed bone erosion, subchondral osteomyelitis, and synovitis in bilateral SIJ. DECT demonstrated urate crystals attached to SIJ (Figure 1A and 1B).

Figure 1.
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Figure 1.

DECT of sacroiliac joints in gouty sacroiliitis. DECT was performed by GE Discovery CT750HD in accordance with manufacturer’s protocol. Red spots indicate monosodium urate crystal deposits. (A and B) Case 1. (C and D) Case 2. DECT: dual-energy computed tomography.

Case 2

A 40-year-old woman with a 10-year history of untreated hyperuricemia was admitted because of peripheral arthritis and tophus. She also claimed low back pain. Laboratory tests showed elevated CRP (39.9 mg/dl) and hyperuricemia (8.2 mg/dl). HLA-B27 was negative. A joint fluid aspiration from elbows contained urate crystals and neutrophils. Sacroiliitis was suspected by sclerosis in computed tomography and synovitis in MRI. DECT showed urate crystals attached to the right SIJ (Figure 1C and 1D). Both cases were treated by steroid and febuxostat; however, they showed recurrences of gouty attacks.

In this way, DECT provides important evidence for a diagnosis of gouty spondyloarthritis with minimal invasion.

Acknowledgment

We thank Dr. Yusuke Sugimori, Dr. Oh Sasaki, Dr. Hiroaki Harada, and Dr. Keishi Fujio from the Department of Allergy and Rheumatology for their diagnosis and assistance with this report.

REFERENCES

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    5. Louis L,
    6. Munk P
    . Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. AJR Am J Roentgenol 2010;194:1072–8.
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    1. Dhaese S,
    2. Stryckers M,
    3. Van Der Meersch H,
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    . Gouty arthritis of the spine in a renal transplant patient: a clinical case report: an unusual presentation of a common disorder. Medicine 2015;94:e676.
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    . Detection of lumbar facet joint gouty arthritis using dual-energy computed tomography. J Rheumatol 2010;37:2190–1.
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Two Cases of Gouty Sacroiliitis Evaluated by Dual-energy Computed Tomography
TOMOKA AO, HIROFUMI SHODA, KAZUHIKO YAMAMOTO
The Journal of Rheumatology Jun 2016, 43 (6) 1146-1147; DOI: 10.3899/jrheum.151454

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Two Cases of Gouty Sacroiliitis Evaluated by Dual-energy Computed Tomography
TOMOKA AO, HIROFUMI SHODA, KAZUHIKO YAMAMOTO
The Journal of Rheumatology Jun 2016, 43 (6) 1146-1147; DOI: 10.3899/jrheum.151454
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