Gout as a Crystal Burden Disease: The Role of Dual-Energy Computed Tomography in the Diagnosis and Monitoring of Urate Deposits
Summary. Gout is a chronic crystal-associated disease in which not only hyperuricemia but also the accumulation of monosodium urate deposits in articular, periarticular, and extra-articular tissues is of clinical significance. Dual-energy computed tomography (DECT) enables noninvasive visualization of urate deposits and assessment of their localization and volume, which is particularly important for the diagnosis of gout in complex clinical situations. The greatest practical value of DECT is observed in cases of atypical arthritis localization, uncertain diagnosis, impossibility or low informativeness of arthrocentesis, and suspected tophaceous or extra-articular urate involvement, including spinal gout. DECT also plays an important role in assessing urate burden and monitoring its dynamics during urate-lowering therapy. In this context, febuxostat is considered a pathogenetically substantiated component of treat-to-target therapy aimed at achieving target serum uric acid levels and gradual reduction of crystal burden. Although DECT is not a method for monitoring a specific drug, it may help objectively assess urate burden, evaluate the risk of disease flares, and emphasize the need for long-term urate-lowering therapy.
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