Clinical Rheumatology

, Volume 34, Issue 2, pp 345–351 | Cite as

An MRI assessment of chronic synovial-based inflammation in gout and its correlation with serum urate levels

  • John D. CarterEmail author
  • Michelle Patelli
  • Scott R. Anderson
  • Neelesh Prakash
  • Ernesto J. Rodriquez
  • Helen Bateman
  • Ashley Sterrett
  • Joanne Valeriano
  • Louis R. Ricca
Original Article


It is unclear when the synovial-based inflammatory process of gout begins. The aim of this study was to determine the percentage of patients with inter-critical gout who have chronic synovial-based inflammation as evidenced by synovial pannus on a contrast-enhanced magnetic resonance imaging (MRI) of their most involved joint and determine if the presence and/or severity correlates with their serum urate levels. All patients received a 3 T MRI of their index joint, serum urate level, CRP, and creatinine. The primary endpoint was to determine the prevalence of synovial pannus and the correlation of serum urate levels with the presence and/or severity of the synovial pannus on that same joint. MRI erosions, tophi, swelling, effusion, and osteitis were also documented. Seventy-two of 74 subjects (90 % men) completed the protocol. Fifty-three of 72 (74 %) index joints were the first metatarsophalangeal joint. Thirty-nine (54.2 %) of the patients were on urate-lowering therapy; 15 (20.8 %) and 7 (9.7 %) were taking colchicine or a NSAID daily, respectively. Of the 72 subjects, 63 (87.5 %) had synovial pannus on their MRI with good inter-reader agreement between the two radiologists. The mean serum urate level was 7.93 mg/dL. There was no correlation with the presence (p = 0.33) or severity (p = 0.34) of synovial pannus and serum urate levels. There was also no correlation with the presence or severity of synovial pannus and the secondary endpoints. The majority of patients with inter-critical gout have evidence of chronic synovial-based inflammation. However, the presence and severity of this inflammation do not appear to correlate with serum urate levels.


Gout Magnetic resonance imaging (MRI) Serum urate levels Synovial pannus 



This study was funded by an investigator-initiated grant from Takeda Pharmaceuticals NA, Inc., and support was provided by Takeda Pharmaceuticals USA, Inc. We would like to thank Ren Chen, Senior Biostatistician, Biostatistical Core, Clinical and Translational Science Institute at the University of South Florida College of Medicine, for assistance.

Conflicts of interest

John D. Carter received grants from Takeda Pharmaceuticals NA, Inc.; Genentech; and Speakers’ Bureaus of Amgen, Abbvie, and Takeda. All other authors have nothing to disclose.


  1. 1.
    Liu-Bryan R, Scott P, Sydlaske A, Rose DM, Terkeltaub R (2005) Innate immunity conferred by Toll-like receptors 2 and 4 and myeloid differentiation factor 88 expression is pivotal to monosodium urate monohydrate crystal-induced inflammation. Arthritis Rheum 52:2936–46PubMedCrossRefGoogle Scholar
  2. 2.
    Martinon F, Pétrilli V, Mayor A, Tardivel A, Tschopp J (2006) Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 440(7081):237–41PubMedCrossRefGoogle Scholar
  3. 3.
    Chen CK, Chung CB, Yeh L, Pan HB, Yang CF, Lai PH, Liang HL, Resnick D (2000) Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients. AJR Am J Roentgenol 175(3):655–9PubMedCrossRefGoogle Scholar
  4. 4.
    Chen CK, Yeh LR, Pan HB, Yang CF, Lu YC, Wang JS, Resnick D (1999) Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skelet Radiol 28(2):75–80CrossRefGoogle Scholar
  5. 5.
    Gentili A (2003) Advanced imaging of gout. Semin Musculoskelet Radiol 7(3):165–74PubMedCrossRefGoogle Scholar
  6. 6.
    Yu JS, Chung C, Recht M, Dailiana T, Jurdi R (1997) MR imaging of tophaceous gout. AJR Am J Roentgenol 168(2):523–7PubMedCrossRefGoogle Scholar
  7. 7.
    Cimmino MA, Zampogna G, Parodi M, Andracco R, Barbieri F, Paparo F, Ferrero G, Garlaschi G (2011) MRI synovitis and bone lesions are common in acute gouty arthritis of the wrist even during the first attack. Ann Rheum Dis 70(12):2238–9PubMedCrossRefGoogle Scholar
  8. 8.
    Poh YJ, Dalbeth N, Doyle A, McQueen FM (2011) 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 38(11):2475–81PubMedCrossRefGoogle Scholar
  9. 9.
    Popp JD, Bidgood WD Jr, Edwards NL (1996) Magnetic resonance imaging of tophaceous gout in the hands and wrists. Semin Arthritis Rheum 25(4):282–9PubMedCrossRefGoogle Scholar
  10. 10.
    Gerster JC, Landry M, Dufresne L, Meuwly JY (2002) Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis 61(1):52–4PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Dalbeth N, Doyle A, McQueen FM (2012) Imaging in gout: insights into the pathological features of disease. Curr Opin Rheumatol 24(2):132–8PubMedGoogle Scholar
  12. 12.
    Schueller-Weidekamm C, Schueller G, Aringer M et al (2007) Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings. Eur J Radiol 62:437–43PubMedCrossRefGoogle Scholar
  13. 13.
    Wright SA, Filippucci E, McVeigh C et al (2007) High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis 66:859–64PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Carter JD, Kedar RP, Anderson SR, Osorio AH, Albritton NL, Gnanashanmugam S, Valeriano-Marcet J, Vasey FB, Ricca LR (2009) MRI and ultrasound findings in patients with gout and normal plain radiographs. Rheumatology (Oxford) 48(11):1442–6CrossRefGoogle Scholar
  15. 15.
    Pascual E, Batlle-Gualda E, Martínez A, Rosas J, Vela P (1999) Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 131(10):756–9PubMedCrossRefGoogle Scholar
  16. 16.
    Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü T-F (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20(3):895–900PubMedCrossRefGoogle Scholar
  17. 17.
    Argyropoulou MI, Fanis SL, Xenakis T, Efremidis SC, Siamopoulou A (2002) The role of MRI in the evaluation of hip joint disease in clinical subtypes of juvenile idiopathic arthritis. Br J Radiol 75(891):229–33PubMedCrossRefGoogle Scholar
  18. 18.
    Østergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B, Shnier R, O’Connor P, Klarlund M, Emery P, Genant H, Lassere M, Edmonds J (2003) OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30(6):1385–6PubMedGoogle Scholar
  19. 19.
    Loeb JN (1972) The influence of temperature on the solubility of monosodium urate. Arthritis Rheum 15:189–192PubMedCrossRefGoogle Scholar
  20. 20.
    Bomalaski JS, Lluberas G, Schumacher HR Jr (1986) Monosodium urate crystals in the knee joints of patients with asymptomatic nontophaceous gout. Arthritis Rheum 29(12):1480–4PubMedCrossRefGoogle Scholar
  21. 21.
    McCarthy GM, Barthelemy CR, Veum JA, Wortmann RL (1991) Influence of antihyperuricemic therapy on the clinical and radiographic progression of gout. Arthritis Rheum 34(12):1489–94PubMedCrossRefGoogle Scholar
  22. 22.
    Dalbeth N, Doyle AJ, McQueen FM, Sundy J, Baraf HS (2013) Exploratory study of radiographic change in patients with tophaceous gout treated with intensive urate-lowering therapy. Arthritis Care Res (Hoboken). doi: 10.1002/acr.22059 Google Scholar
  23. 23.
    Javaid MK, Kiran A, Guermazi A, Kwoh CK, Zaim S, Carbone L, Harris T, McCulloch CE, Arden NK, Lane NE, Felson D, Nevitt M, Health ABC (2012) Study. Individual magnetic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain: the health, aging, and body composition study. Arthritis Rheum 64(10):3246–55PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Haugen IK, Lillegraven S, Slatkowsky-Christensen B, Haavardsholm EA, Sesseng S, Kvien TK, van der Heijde D, Bøyesen P (2011) Hand osteoarthritis and MRI: development and first validation step of the proposed Oslo Hand Osteoarthritis MRI score. Ann Rheum Dis 70(6):1033–8PubMedCrossRefGoogle Scholar
  25. 25.
    Roemer FW, Guermazi A, Felson DT, Niu J, Nevitt MC, Crema MD, Lynch JA, Lewis CE, Torner J, Zhang Y (2011) Presence of MRI-detected joint effusion and synovitis increases the risk of cartilage loss in knees without osteoarthritis at 30-month follow-up: the MOST study. Ann Rheum Dis 70(10):1804–9PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2014

Authors and Affiliations

  • John D. Carter
    • 1
    Email author
  • Michelle Patelli
    • 1
  • Scott R. Anderson
    • 1
  • Neelesh Prakash
    • 1
  • Ernesto J. Rodriquez
    • 1
  • Helen Bateman
    • 1
  • Ashley Sterrett
    • 1
  • Joanne Valeriano
    • 1
  • Louis R. Ricca
    • 1
  1. 1.University of South FloridaTampaUSA

Personalised recommendations