URATE DEPOSITION CAN OCCUR OUTSIDE OF JOINTS1,2
Recent studies have shown that, in addition to joints, uric acid crystals have been found in organs such as the kidney and heart.3,4 Furthermore, even nonvisible urate crystal deposits can trigger local inflammation and cause bone erosion.1,2,5-7
URATE DEPOSITION CAN OCCUR ALMOST ANYWHERE IN THE BODY1,2
DECT imaging of urate deposits on the bones and joints. Green areas depict the uric acid crystal depositions.
Tophus, with central urate deposition, surrounded by mononuclear inflammatory cells and scattered giant cells (arrow).3
Microtophus in the intima of a left anterior descending artery.4
DECT=dual-energy computed tomography.
DECT image courtesy of Dr Jürgen Rech.
Nickeleit V et al, Uric acid nephropathy and end-stage renal disease–review of a non-disease, Nephrol Dial Transplant, 1997, 12(9), 1832-1838, by permission of Oxford University Press.
Reproduced from Prevalence of birefringent crystals in cardiac and prostatic tissues, an observational study, Park JJ et al, 4, 1-6, 2014, with permission from BMJ Publishing Group Ltd.
You couldn’t see tophi, per se, but her joints were deformed, and they were swollen... And I thought, let’s try KRYSTEXXA on her.
Hear more from nephrologist Payam Shakouri about what happened when he prescribed KRYSTEXXA to a patient with uncontrolled gout.Watch Video
BONE EROSIONS CAN RESULT FROM SYSTEMIC URATE DEPOSITION5,6
Dalbeth et al (2015) found a close relationship between urate crystal deposition, tophus formation, and structural joint damage.6
Both nonvisible and visible tophi were associated with higher bone erosion scores.6
- Chronic urate crystal deposition leads to inflammation triggered by the interactions between monosodium urate microcrystals and the local tissue environment7
- The presence of urate crystals in joints is frequently associated with erosions5,6
Radiograph of the left thumb shows tophi and erosions. White arrows indicate sclerotic overhanging edges.8
Photo courtesy of Dr. Raj Carmona.
Microtophi (nonvisible urate deposits) may lead to bone damage even in the absence of pain1,2,7
- Edwards NL. Gout A. Clinical features. In: Klippel JK, et al, eds. Primer on the Rheumatic Diseases. 13th ed. New York, NY: Springer: 2008:241-249.
- Doghramji PP, et al. Postgrad Med. 2012;124:98-109.
- Nickeleit V, et al. Nephrol Dial Transplant. 1997;12:1832-1838.
- Park JJ, et al. BMJ Open. 2014;4:1-6.
- McQueen FM, et al. Nat Rev Rheumatol. 2012;8:173-181.
- Dalbeth N, et al. Ann Rheum Dis. 2015;74:1030-1036.
- Schett G, et al. RMD Open. 2015;1(suppl 1):1-6.
- RheumTutor.com. https://www.rheumtutor.com/rheumtutoring/gout-hand-radiograph. Accessed November 29, 2018.