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Tendon Involvement in Patients with Gout

Summary and Comment |
October 17, 2013

Tendon Involvement in Patients with Gout

  1. Allan S. Brett, MD

Dual-energy computed tomography demonstrates high prevalence, especially in the Achilles and peroneal tendons.

  1. Allan S. Brett, MD

Dual-energy computed tomography (CT) can be used to identify sites of monosodium urate (MSU) crystal deposition in patients with gout (NEJM JW Gen Med Nov 29 2011). In this study, New Zealand researchers performed dual-energy CT of the feet to determine the prevalence of tendon and ligament involvement in 92 patients with known tophaceous gout.

MSU crystal deposition was noted in bone in 72% of patients, and 65% had tendon or ligament involvement (mostly tendon; ligament involvement was rare). The most common sites of tendon involvement were the Achilles (52% of patients), peroneal (29%), extensor digitorum longus (16%), tibialis anterior (15%), and extensor hallucis longus (14%). Involvement more often was nonenthesial (i.e., not at the point of tendon insertion into bone) than entheseal.

Comment

This study demonstrates that tendon involvement is common in the feet of patients with known chronic tophaceous gout. The next step would be to determine whether dual-energy CT could be helpful in patients without gout histories who present with recurrent tendinitis and whose clinical characteristics suggest high risk for gout. Examples of dual-energy CT images of gout are available online (Radiographics 2011; 31:1365).

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

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