Distress, as assessed by gout flares.
| Authors, Year | Study Design | Population | Follow-up | Outcomes |
|---|---|---|---|---|
| Dalbeth et al, 201945 | Cross-sectional analysis nested in 2-year randomized trial; 1 group received allopurinol dose escalation to SUA target (< 6 mg/dL) from start; the second received conventional dosing for 1 year with dose adjustments after 1 yr | 87 participants; mean age 60 (SD 13) yrs; 92.0% males; mean gout duration 19 (SD 14) yrs | DECT was performed at baseline, year 1, and year 2 | DECT volumes were higher at 1 and 2 yrs in those without SUA control; at yr 1, DECT volumes were 0.62 cm3 in patients without SUA control vs 0.46 cm3 with SUA control; at yr 2, DECT volumes were 0.77 cm3 in patients without SUA control vs 0.20 cm3 with SUA control; gout flares at yr 2 showed DECT volume with flares of 2.60 cm3 (95% CI 2.30-3.00) vs 2.10 cm3 (95% CI 2.00-2.20) without flares (P < 0.001) |
| Dalbeth et al, 201812 | Prospective cohort study; patients treated with allopurinol > 300 mg/day for > 3 months prior to entry; DECT of hands and wrists, feet/ankles/Achilles and knees bilaterally done within 28 days; patients from 9 USA centers and 1 NZ center | 223 patients eligible, 153 patients with interpretable DECT, 152 in analyses; central DECT reading in Vancouver, Canada; adults (18-85 yrs), all met ARA criteria for gout; approximately 25.0% had palpable tophi and 50.0% had elevated SUA levels | Analysis was correlational; relationship of DECT volume against clinical variables examined; no multivariable analysis | 83.3% of patients with abnormal DECT scans had flares in past 3 months vs 63.6% with abnormal DECT scans but no flares (P = 0.019); greater DECT volume associated with the following 1) SUA levels ≥ 6 mg/dL; 2) > 1 gout flare; 3) allopurinol dose > 300 mg/day; DECT abnormal in 46.9% of patients with SUA < 6.0 mg/dL and no palpable tophi, and up to 90.0% for those with SUA > 6.0 mg/dL and palpable tophi; DECT volume increased with increasing tophi counts |
| Gamala et al, 20188 | Retrospective clinical analysis of all adult patients with DECT imaging from January 2013 to December 2014; DECT assessed by MSK radiologist | 147 patients with mean age 63 (SD 2) yrs; 68.0% males; mean gout disease duration 3 (SD 7) yrs | Cross-sectional analysis, no follow-up; variables with P < 0.100 in univariate analyses brought into multivariate models; DECT result as positive or negative was the outcome variable | Multivariable regression model showed CVD (OR 3.07, 95% CI 1.26-7.47), gout duration (OR 1.01, 95% CI 1.00-1.02), frequency of attacks (OR 1.23, 95% CI 1.07-1.42), and creatinine clearance (OR 2.03, 95% CI 0.91-1.00) to all be independently associated with positive DECT scans |
| Pascart et al, 201846 | Cohort study recruited gout patients; urate burden assessed by DECT and US | 36 of 78 patients had all assessments, including DECT performed; mean age of 64 (SD 14) yrs; 87.0% males; mean gout duration 12 (SD 12) years; mean number of flares reported over past 12 months 4.10 (SD 1.30) | Patients followed up at 3, 6, and 12 months; univariate and multivariate analyses using logistic regression | At 6 months on univariate analysis, factors associated with flare risk (P ≤ 0.100) were as follows: 1) hypertension: patients without flare = 22 (66.7%) vs patients with ≥ 1 flare = 5 (26.3%), chi-square, P = 0.012; 2) gout duration: patients without flare, mean 10 (SD 11) yrs vs patients with ≥ 1 flare, mean 15 (SD 13) yrs, t test, P = 0.061; 3) DECT volume in feet: patients without flare, mean 0.90 (SD 1.30) cm3 vs patients with at least 1 flare, mean 2.40 (SD 2.1) cm3, t test P = 0.006; 4) subcutaneous tophi: patients without flare, n = 7 (21.2%) vs patients with at least 1 flare, n = 9 (47.4%), chi-square, P = 0.098; On multivariable analysis, DECT volume was the only predictor of flares; DECT volume at feet with flares, mean 2.10 (SD 1.9) cm3 vs with no flares, mean 0.9 (SD 0.08) cm3, P = 0.050; flare risk was 2.03 times greater for each 1.00-cm3 increase in DECT volume in feet |
ARA: American Rheumatism Association; CVD: cardiovascular disease; DECT: dual-energy computed tomography; MSK: musculoskeletal; NZ: New Zealand; OR: odds ratio; SUA: serum uric acid; US: ultrasound.