Background Seronegative Oligo/Polyarthritis combines a set of diseases including gout as a possible differential diagnosis.
The identification of monosodium urate crystals is the gold standard for the proof of gout. However, the puncture of small finger and toe joints maybe a challenge and is therefore often not applicable.
Methods A retrospective analysis of 49 patients was used to investigate the value of Dual-Energy CT for differential diagnosis in patients with seronegative arthropathies.
Puncture and analysis of the joint fluid was possible in 15 patients, whereas Dual-Energy CT without puncture could be performed in the remaining 34 patients.
Results In the first group of patients (n=15), where a crystal analysis was available, urate crystals could be indentified in 14 and Dual-Energy CT investigation confirmed monosodium urate depositions in 11 of these patients.In 3 cases with positive urate crystal detection in joint fluid gout-CT was negative.In one case pyrophosphate crystals were identified and no urate depositions in gout-CT could be detected.
In the second group (n=34) joint puncture could not be performed as the affected joints were small finger and toe joints.21 of these patients revealed urate depositions in Dual-Energy CT. In these cases the diagnosis of gout was confirmed and appropriate therapy could be started. 17 out of these 21 patients had elevated uric acid levels.
Conclusions Dual-Energy CT can be applied as a tool for diagnosing gout in patients with seronegative inflammatory arthropathy especially in the case of polyarticular joint involvement and no possibility of joint puncture.
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Disclosure of Interest None Declared
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