Dual energy computed tomography for quantification of tissue urate deposits in tophaceous gout: help from modern physics in the management of an ancient disease

Rheumatol Int. 2012 Jan;32(1):235-9. doi: 10.1007/s00296-009-1295-7. Epub 2009 Dec 17.


Gout has been recognized for centuries but is also a modern day scourge. It is the most common type of inflammatory arthritis in men and appears to be increasing in both incidence and prevalence (Arromdee et al. in J Rheumatol 29(11):2403-2406, 2002). Despite these facts, few advances have been made in the diagnosis and treatment of gout for over 50 years. Difficult cases of gout challenge available therapeutic options. It is only recently that the Food and Drug Administration has approved febuxostat as a treatment option for patients intolerant of allopurinol. We describe a difficult case of tophaceous gout notable for several reasons: utilization of rasburicase as uricolytic treatment to dramatically reduce tissue urate burden; treatment of gout flares with interleukin-1β inhibition; and quantification of tissue urate with novel dual energy computed tomography technology before and after uricolytic therapy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Gout / diagnostic imaging*
  • Gout / drug therapy*
  • Gout / metabolism
  • Gout Suppressants / pharmacology
  • Gout Suppressants / therapeutic use
  • Hand Joints / diagnostic imaging*
  • Hand Joints / drug effects
  • Hand Joints / metabolism
  • Humans
  • Interleukin 1 Receptor Antagonist Protein / pharmacology
  • Interleukin 1 Receptor Antagonist Protein / therapeutic use
  • Interleukin-1beta / antagonists & inhibitors
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed / methods*
  • Treatment Outcome
  • Urate Oxidase / pharmacology
  • Urate Oxidase / therapeutic use*
  • Uric Acid / metabolism*
  • Wrist Joint / diagnostic imaging*
  • Wrist Joint / drug effects
  • Wrist Joint / metabolism


  • Gout Suppressants
  • Interleukin 1 Receptor Antagonist Protein
  • Interleukin-1beta
  • rasburicase
  • Uric Acid
  • Urate Oxidase