Monosodium urate (MSU) crystal deposits correlate with the degree of bone erosion displayed on dual-energy computed tomography (DECT), which may identify gout progression and joint damage earlier.

Using DECT, investigators assessed MSU crystals volume and bone erosion in the metatarsophalangeal joints of 56 patients with gout. Among the 560 metatarsophalangeal joints, 80 showed MSU crystal deposition, and 108 showed bone erosion. The investigators evaluated erosion using a modified version of the Sharp/van der Heijde erosion scoring method, which focuses only on the metatarsophalangeal (MTP) joints. They scored erosion to each joint on a scale of 1 to 10 (0 to 5 for each articular surface). The investigators calculated an overall erosion score, which was the sum of the erosion scores for each joint. The maximum possible bone erosion score was 50 for each foot.

Among the 56 patients, 30 had urate deposits in the MTP joints of the feet and 26 did not, according to DECT. Bone erosion occurred in both groups but was significantly more severe in the group with than without urate deposits, with a mean overall erosion score of 14.27 vs 1.38, Gui-Hua Jiang, MD, of The Affiliated Guangdong Second Provincial General Hospital of Jinan University in Guangzhou, China, and colleagues reported in Frontiers in Endocrinology.

Continue Reading

The volume of MSU crystals was strongly associated with the degree of bone erosion with a Spearman correction coefficient of 0.714, Dr Jiang’s team reported.

Serum uric acid levels did not differ between the groups with and without urate deposits (498.67 vs 453.92 μmol/L). Symptom duration, however, was significantly longer in the urate deposits group (mean 107.63 vs 84.64 months). The urate deposits group also had a significantly higher rate of kidney stones (30% vs 0%).

The investigators plan to validate their findings in future studies involving more joints and a larger sample size.

“DECT can effectively monitor MSU deposits and observe changes in bone erosion, and this can be considered as a supplement to serum uric acid measurement in clinical practice to improve the prognostic evaluation of patients with gout and guide follow-up as well as individualized treatment plans,” Dr Jiang’s team wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Zheng WY, Zhan WF, Wang JY, et al. Detailed analysis of the association between urate deposition and bone erosion in gout: a dual-energy computed tomography study. Front Endocrinol. Published online April 17, 2023. doi:10.3389/fendo.2023.1167756