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Assessing tophaceous spinal gout treatment response using dual-energy CT as a point-of-care imaging modality: case report

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Abstract

We describe a case of chronic tophaceous gout affecting the spine, hands, elbows, feet, and knees in a 67-year-old man with serum urate levels at 549 µmol/L whose response to treatment was successfully mapped using dual-energy computed tomography (DECT). The patient presented with exacerbation of acute-on-chronic lumbar back pain. He had received a diagnosis of gout 3 years prior to this presentation yet was not on any urate-lowering therapy. The patient received febuxostat 80 mg and colchicine 0.3 mg once daily and underwent DECT to assess baseline monosodium urate (MSU) burden. At baseline, MSU deposits were seen in the hands, elbows, feet, knees, and lumbar spine including the left L5–S1 facet joint encroaching onto the neural foramen. After 2.5 years of treatment, serum urate level was within the target range (< 360 µmol/L), and the patient underwent a follow-up DECT that revealed almost full resolution of MSU deposition in the spine, including the MSU-burdened facet joint and neural foramen in the lumbar spine, in addition to all the affected peripheral joints. This case is the first report of radiological evidence of nearly complete resolution of MSU deposits in spinal gout on DECT after urate-lowering therapy treatment, which demonstrates the utility of this imaging modality as a non-invasive investigational point-of-care imaging modality for mapping treatment response and identifying the etiology of back pain in a patient with chronic tophaceous spinal gout.

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Authors and Affiliations

  1. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Mohammadali Saffarzadeh, Syed M. A. Haydar, Kamran Shojania, Hugue Ouellette, Savvas Nicolaou & Nicolas Murray

  2. Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada

    Syed M. A. Haydar, Hugue Ouellette, Savvas Nicolaou & Nicolas Murray

  3. Division of Rheumatology, Vancouver General Hospital, Vancouver, British Columbia, Canada

    Kamran Shojania

  4. Arthritis Research Canada, Vancouver, British Columbia, Canada

    Kamran Shojania

Authors
  1. Mohammadali Saffarzadeh
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  2. Syed M. A. Haydar
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  3. Kamran Shojania
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  4. Hugue Ouellette
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  5. Savvas Nicolaou
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  6. Nicolas Murray
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Contributions

All authors contributed to the conceptualization of this manuscript and to the content. Mohammadali Saffarzadeh and Dr. Syed M.A. Haydar took the lead in drafting the manuscript, analyzing figures, and providing radiological details of the included case. Dr. Kamran Shojania provided clinical correlation of the radiological findings and provided expertise and details on the medical management of the case. Dr. Hugue Ouellette, Dr. Savvas Nicolaou, and Dr. Nicolas Murray took a main part in refining the idea of the manuscript and were the senior radiologists. All authors provided input at every stage of development and approved the final draft and its submission.

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Correspondence to Mohammadali Saffarzadeh.

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Saffarzadeh, M., Haydar, S.M.A., Shojania, K. et al. Assessing tophaceous spinal gout treatment response using dual-energy CT as a point-of-care imaging modality: case report. Skeletal Radiol 52, 1599–1604 (2023). https://doi.org/10.1007/s00256-022-04260-w

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  • DOI: https://doi.org/10.1007/s00256-022-04260-w

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