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CT Can Help Diagnose Difficult Cases Of Gout

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Dual-energy CT scans do a nice job of detecting hard-to-diagnose cases of gout, according to a new open-access study published last week in Annals of the Rheumatic Diseases, the European League Against Rheumatism journal.

Gout, the most common form of inflammatory arthritis, is on the increase. Mayo Clinic says the disease, in which uric acid crystals cause sharp joint pain, now afflicts 5 percent of adult African-Americans and 4 percent of adult Caucasians in the United States. But it can be hard to pin down, said Tim Bongartz, MD, a Mayo rheumatologist in Rochester, Minnesota.

Dr. Bongartz is lead author of the new study. He said the study included some subjects who had experienced flares of gout-like pain but whose initial tests—needle aspiration of fluid or tissue from an affected joint—had come back negative:

These were in part patients that had been falsely diagnosed with diseases like rheumatoid arthritis or labeled with a different type of inflammatory arthritis, resulting in a completely different and often not effective treatment approach.

Dr. Bongartz was quoted in a Mayo Clinic News Network blog post.

During the study, CT scans found uric acid crystals hiding in unexpected places in one third of patients whose aspirates had come back negative. After the CT scans found the elusive crystals, ultrasound-guided aspiration of the deposits confirmed the diagnosis.

Dr. Bongartz said CT should be a supplemental tool, not the first means of diagnosis. It was less effective with patients having their first gout symptoms, he said.

Nevertheless, he said, CT scans have given researchers a better understanding of the disease. “What we are learning from the dual-energy CT scans has really changed our perception of where gout can occur and how it can manifiest,” he said. “The ability to visualize those deposits clearly broadens our perspective on gout.”

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