Skip to main content
SpringerLink
Log in

Exploring cartilage damage in gout using 3-T MRI: distribution and associations with joint inflammation and tophus deposition

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

Few imaging studies have investigated cartilage in gout. Magnetic resonance imaging (MRI) can image cartilage damage and also reveals other features of gouty arthropathy. The objective was to develop and validate a system for quantifying cartilage damage in gout.

Methods

3-T MRI scans of the wrist were obtained in 40 gout patients. MRI cartilage damage was quantified using an adaptation of the radiographic Sharp van der Heijde score. Two readers scored cartilage loss at 7 wrist joints: 0 (normal), 1 (partial narrowing), 2 (complete narrowing) and concomitant osteoarthritis was recorded. Bone erosion, bone oedema and synovitis were scored (RAMRIS) and tophi were assessed. Correlations between radiographic and MRI cartilage scores were investigated, as was the reliability of the MRI cartilage score and its associations.

Results

The GOut MRI Cartilage Score (GOMRICS) was highly correlated with the total Sharp van der Heijde (SvdH) score and the joint space narrowing component (R = 0.8 and 0.71 respectively, p < 0.001). Reliability was high (intraobserver, interobserver ICCs = 0.87 [0.57–0.97], 0.64 [0.41–0.79] respectively), and improved on unenhanced scans; interobserver ICC = 0.82 [0.49–0.95]. Cartilage damage was predominantly focal (82 % of lesions) and identified in 40 out of 280 (14 %) of joints. Cartilage scores correlated with bone erosion (R = 0.57), tophus size (R = 0.52), and synovitis (R = 0.55), but not bone oedema scores.

Conclusions

Magnetic resonance imaging can be used to investigate cartilage in gout. Cartilage damage was relatively uncommon, focal, and associated with bone erosions, tophi and synovitis, but not bone oedema. This emphasises the unique pathophysiology of gout.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Dalbeth N, Clark B, Gregory K, Gamble G, Sheehan T, Doyle A, et al. Mechanisms of bone erosion in gout: a quantitative analysis using plain radiography and computed tomography. Ann Rheum Dis. 2009;68(8):1290–5.

    Article  CAS  PubMed  Google Scholar 

  2. Brailsford JF. The radiology of gout. Br J Radiol. 1959;32:472–8.

    Article  CAS  PubMed  Google Scholar 

  3. Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology. 2007;46(7):1116–21.

    Article  CAS  PubMed  Google Scholar 

  4. Howard RG, Pillinger MH, Gyftopoulos S, Thiele RG, Swearingen CJ, Samuels J. Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: concordance between readers. Arthritis Care Res. 2011;63(10):1456–62.

    Article  CAS  Google Scholar 

  5. De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martin-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis. 2012;71(1):157–8.

    Article  PubMed  Google Scholar 

  6. Muehleman C, Li J, Aigner T, Rappoport L, Mattson E, Hirschmugl C, et al. Association between crystals and cartilage degeneration in the ankle. J Rheumatol. 2008;35(6):1108–17.

    CAS  PubMed  Google Scholar 

  7. Roddy E, Zhang W, Doherty M. Are joints affected by gout also affected by osteoarthritis? Ann Rheum Dis. 2007;66(10):1374–7.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Ostergaard M, Boyesen P, Eshed I, Gandjbakhch F, Lillegraven S, Bird P, et al. Development and preliminary validation of a magnetic resonance imaging joint space narrowing score for use in rheumatoid arthritis: potential adjunct to the OMERACT RA MRI scoring system. J Rheumatol. 2011;38(9):2045–50.

    Article  PubMed  Google Scholar 

  9. McQueen FM, Clarke A, McHaffie A, Reeves Q, Williams M, Robinson E, et al. Assessment of cartilage loss at the wrist in rheumatoid arthritis using a new MRI scoring system. Ann Rheum Dis. 2010;69:1971–1975.

    Article  PubMed  Google Scholar 

  10. Cohen ZA, McCarthy DM, Kwak SD, Legrand P, Fogarasi F, Ciaccio EJ, et al. Knee cartilage topography, thickness, and contact areas from MRI: in-vitro calibration and in-vivo measurements. Osteoarthritis Cartilage. 1999;7(1):95–109.

    Article  CAS  PubMed  Google Scholar 

  11. Eckstein F, Buck RJ, Burstein D, Charles HC, Crim J, Hudelmaier M, et al. Precision of 3.0 Tesla quantitative magnetic resonance imaging of cartilage morphology in a multi center clinical trial. Ann Rheum Dis. 2008;67(12):1683–8.

    Article  CAS  PubMed  Google Scholar 

  12. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20(3):895–900.

    Article  CAS  PubMed  Google Scholar 

  13. Van Groen MM, ten Klooster PM, Taal E, van de Laar MAFJ, Glas CAW. Application of the health assessment questionnaire disability index to various rheumatic diseases. Qual Life Res. 2010;19(9):1255–63.

    Google Scholar 

  14. Van der Heijde DM, van Riel PL, Nuver-Zwart IH, Gribnau FW, vad de Putte LB. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet. 1989;1(8646):1036–8.

    Google Scholar 

  15. Østergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B, et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol. 2003;30(6):1385–6.

    PubMed  Google Scholar 

  16. McQueen FM, Doyle A, Reeves Q, Gao A, Tsai A, Gamble GD, Curteis B, Williams M, Dalbeth N. Bone erosions in patients with chronic gouty arthropathy are associated with tophi but not bone oedema or synovitis: new insights from a 3 T MRI study. Rheumatology (Oxford). 2014;53(1):95–103

    Google Scholar 

  17. Guillemin F, Billot L, Boini S, Gerard N, Odegaard S, Kvien TK. Reproducibility and sensitivity to change of 5 methods for scoring hand radiographic damage in patients with rheumatoid arthritis. [Erratum appears in J Rheumatol. 2005 Jul;32(7):1414]. J Rheumatol. 2005;32(5):778–86.

    PubMed  Google Scholar 

  18. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.

    Article  CAS  PubMed  Google Scholar 

  19. McQueen FMF, Doyle AJ, Reeves Q, Gamble GD, Dalbeth N. DECT urate deposits: now you see them, now you don’t. Ann Rheum Dis. 2013;72(3):458–9.

    Article  PubMed  Google Scholar 

  20. Haavardsholm EA, Ostergaard M, Ejbjerg BJ, Kvan NP, Uhlig TA, Lilleas FG, et al. Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting. Arthritis Rheum. 2005;52(12):3860–7.

    Article  PubMed  Google Scholar 

  21. Dalbeth N, Smith T, Nicolson B, Clark B, Callon K, Naot D, et al. Enhanced osteoclastogenesis in patients with tophaceous gout: urate crystals promote osteoclast development through interactions with stromal cells. Arthritis Rheum. 2008;58(6):1854–65.

    Article  CAS  PubMed  Google Scholar 

  22. Busso N, So A. Mechanisms of inflammation in gout. Arthritis Res Ther. 2010;12(2):206.

    Article  PubMed Central  PubMed  Google Scholar 

  23. McQueen FM, McHaffie A, Clarke A, Lee AC, Reeves Q, Curteis B, Dalbeth N. MRI osteitis predicts cartilage damage at the wrist in RA: a three year prospective 3T- MRI study examining cartilage damage. Arthritis Res Ther 2014;16:R33.

    Google Scholar 

  24. Trentham DE, Hamm RL, Masi AT. Wrist arthrography: review and comparison of normals, rheumatoid arthritis and gout patients. Semin Arthritis Rheum. 1975;5(2):105–20.

    Article  CAS  PubMed  Google Scholar 

  25. Wilczynski MC, Gelberman RH, Adams A, Goldfarb CA. Arthroscopic findings in gout of the wrist. J Hand Surg Am. 2009;34(2):244–50.

    Article  PubMed  Google Scholar 

  26. Dalbeth N, Doyle AJ, McQueen FM, Sundy J, Baraf HS. Exploratory study of radiographic change in patients with tophaceous gout treated with intensive urate-lowering therapy. Arthritis Care Res. 2014;66(1):82–5.

    Article  CAS  Google Scholar 

  27. McQueen FM, Ostendorf B. What is MRI bone oedema in rheumatoid arthritis and why does it matter? Arthritis Res Ther. 2006;8:222–5.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Poh YJ, Dalbeth N, Doyle A, McQueen FM. Magnetic resonance imaging bone edema is not a major feature of gout unless there is concomitant osteomyelitis: 10-year findings from a high-prevalence population. J Rheumatol. 2011;38(11):2475–81.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the expert assistance of the MRI technicians at Specialist Radiology and MRI Greenlane, especially Mrs Desiree Mulders. We also acknowledge the assistance of Auckland rheumatology nurses Megan Williams and Barbara Curteis, and we wish to thank the patients and their relatives for involvement in this study.

Conflict of interest

Q. Reeves is part-owner of Specialist Radiology and MRI, Greenlane, where the MRI scans were performed. However, all funding for the study (including the scans) was from the Auckland Medical Research Foundation, which is a charitable institution in New Zealand. All other authors have declared that they have no conflicts of interest.

Sources of support

I. Popovich was funded to take part by the University of Auckland Summer Studentship programme.

Author information

Authors and Affiliations

  1. Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand

    I. Popovich & F. M. McQueen

  2. Department of Medicine, University of Auckland, Auckland, New Zealand

    N. Dalbeth

  3. Department of Radiology, Auckland District Health Board, Auckland, New Zealand

    A. Doyle & Q. Reeves

  4. Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand

    N. Dalbeth & F. M. McQueen

Authors
  1. I. Popovich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Dalbeth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Doyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Q. Reeves
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. M. McQueen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. M. McQueen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Popovich, I., Dalbeth, N., Doyle, A. et al. Exploring cartilage damage in gout using 3-T MRI: distribution and associations with joint inflammation and tophus deposition. Skeletal Radiol 43, 917–924 (2014). https://doi.org/10.1007/s00256-014-1869-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-014-1869-7

Keywords

Search

Navigation