A Webcast Series on Urate Acid Deposition and Gout With Dr Richard Johnson, Nephrologist

While they were once thought to be limited to bones and joints, uric acid crystals are now understood to also deposit in vital organs.1

In this webcast, Dr Johnson presents the case that elevated uric acid and gout should be evaluated for treatment by clinicians who treat patients for diseases such as chronic kidney disease (CKD).

EPISODE 1:

THE LINK BETWEEN GOUT AND CHRONIC KIDNEY DISEASE

Dr Johnson explores the link between gout and chronic kidney disease (CKD) and the importance of evaluating gout when treating patients with CKD.

4:34 

THE LINK BETWEEN GOUT AND CHRONIC KIDNEY DISEASE

EPISODE 2:

PARADIGM SHIFT IN GOUT

Dr Johnson explains the importance of understanding gout as a chronic, progressive systemic urate deposition disease.

4:34

PARADIGM SHIFT IN GOUT

EPISODE 3:

URIC ACID DEPOSITION IN THE KIDNEYS AND VASCULATURE

Dr Johnson shows how urate crystals can deposit in the kidneys as well as in other areas of the body, including the coronaries and aorta.

4:34

URIC ACID DEPOSITION IN THE KIDNEYS AND VASCULATURE

EPISODE 4:

IMPACT ON MORTALITY AND COMORBIDITIES

What’s the impact of gout throughout the body? Dr Johnson explains how the higher the uric acid, the greater the risk for multiple comorbidities.

4:34

IMPACT ON MORTALITY AND COMORBIDITIES

EPISODE 5:

INFLAMMATORY PATHWAY

Dr Johnson discusses the pathophysiology between cholesterol crystals and urate crystals, as well as the concept of inflammation.

4:34

INFLAMMATORY PATHWAY

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Damage coming into focus: Inside Systemic Urate Deposition (SUD)

The extent of urate crystal deposition can be difficult to detect through physical examination alone2; thus, various imaging techniques can be employed to uncover systemic urate crystal deposition and its resulting damage.1,3

See systemic deposition now

MRI of gouty tophi in spine MRI of gouty tophi in spine MRI of gouty tophi in spine

01/11

(43-year-old male) Axial T2-weighted MRI of spine revealing bilateral, mixed-intensity, abnormal soft tissue, involving the right and predominantly the left T11 pedicle (white arrows)

Reproduced from Spinal tophaceous gout encasing the thoracic spinal cord, Subrati N, et al, 1-3, © 2016 with permission from BMJ Publishing Group Ltd.

REFERENCE

Subrati N, et al. BMJ Case Rep. 2016:brc2016214869.

DECT scan of uric acid deposition in aortic arch of heart DECT scan of uric acid deposition in aortic arch of heart DECT scan of uric acid deposition in aortic arch of heart

02/11

DECT (Dual-Energy Computed Tomography) imaging revealing approximately 20 mm2 of uric acid deposition in a patient’s aortic arch (green areas)

Image used with permission from S. Barazani.

REFERENCE

Barazani S, et al. https://acrabstracts.org/abstract/detection-of-uric-acid-crystals-in-the-vasculature-of-patients-with-gout-using-dual-energy-computed-tomography/. Accessed September 2, 2020.

Urate deposits in the eye of a patient with tophaceous gout Urate deposits in the eye of a patient with tophaceous goutUrate deposits in the eye of a patient with tophaceous gout

03/11

Bulbar conjunctiva in patient with tophaceous gout showing many distinct granular deposits of chalky white material (white arrow points to area)

Image used with permissions from Lo WR, et al. Am J Ophthalmol. 2005;140(6):1152-1154.

REFERENCE

Lo WR, et al. Am J Ophthalmol. 2005;140:1152-1154.

Micrograph of urate deposition in the eye of a patient with tophaceous goutMicrograph of urate deposition in the eye of a patient with tophaceous goutMicrograph of urate deposition in the eye of a patient with tophaceous gout

04/11

Light micrograph of bulbar conjunctiva showing multiple tophi composed of eosinophilic material surrounded by histiocytes and foreign body giant cells

Image used with permissions from Lo WR, et al. Am J Ophthalmol. 2005;140(6):1152-1154.

REFERENCE

Lo WR, et al. Am J Ophthalmol. 2005;140:1152-1154.

Multiple Dual Energy CT scans showing urate deposits in feet and ankles, the Achilles tendon, hand, wrist, and elbowMultiple Dual Energy CT scans showing urate deposits in feet and ankles, the Achilles tendon, hand, wrist, and elbowMultiple Dual Energy CT scans showing urate deposits in feet and ankles, the Achilles tendon, hand, wrist, and elbow

05/11

(53-year-old male) DECT imaging revealing large urate crystal deposits along bilateral feet and ankles, the right Achilles tendon, hand, wrist, and proximal elbow (green areas)

Photo courtesy of S. Nicolaou.

REFERENCE

Nicolaou S, et al. AJR Am J Roentgenol. 2012;199(suppl 5):S78-S86.

Dual energy computed tomography scan showing uric acid deposition in knee jointsDual energy computed tomography scan showing uric acid deposition in knee jointsDual energy computed tomography scan showing uric acid deposition in knee joints

06/11

(48-year-old male) DECT imaging showing gout through the bilateral presence of urate crystal deposits in knee joints (green areas)

Photo courtesy of S. Nicolaou.

REFERENCE

Nicolaou S, et al. Am J Roentgenol. 2012;199(suppl 5):S78-S86.

DECT scan revealing urate crystals in temporomandibular jointDECT scan revealing urate crystals in temporomandibular jointDECT scan revealing urate crystals in temporomandibular joint

07/11

(63-year-old female) DECT scan revealing deposition of urate crystals in the right temporomandibular joint (green areas)

Image used with permission, from RadioGraphics 2011;31:1365-1375. © RSNA

REFERENCE

Desai MA, et al. RadioGraphics. 2011;31:1365-1375.

Dual Energy CT scan revealing uric acid deposition in the feet, including along the Achilles tendon, midfoot, and ankle jointDual Energy CT scan revealing uric acid deposition in the feet, including along the Achilles tendon, midfoot, and ankle jointDual Energy CT scan revealing uric acid deposition in the feet, including along the Achilles tendon, midfoot, and ankle joint

08/11

DECT imaging revealing urate crystal deposits along the Achilles tendon, as well as the metatarsophalangeal joints, midfoot, and ankle joint (green areas)

Image used with permission from M. Biermann.

REFERENCE

Biermann M, et al. Gout and Hyperuricemia. 2014;1:122-126.

MRI of an atypical nodule later confirmed to be gouty tophi in the liverMRI of an atypical nodule later confirmed to be gouty tophi in the liver MRI of an atypical nodule later confirmed to be gouty tophi in the liver

09/11

(53-year-old male) MRI of liver displaying alcoholic cirrhosis and an atypical nodule. Nodule was later confirmed to be a gouty tophus (white arrow)

Image used with permission of Elsevier.

REFERENCE

Varinot J, et al. Clin Res Hepatol Gastroenterol. 2011;35:855-856.

CT scan of cystic mass later confirmed to be MSU crystals found in the mid-sternumCT scan of cystic mass later confirmed to be MSU crystals found in the mid-sternum CT scan of cystic mass later confirmed to be MSU crystals found in the mid-sternum

10/11

(73-year-old male) Chest CT scan revealing a cystic mass immediately anterior to the mid sternum. Needle aspiration and microscopy revealed large quantities of monosodium urate crystals (white arrow)

Reproduced from BMJ Case Rep, Wolfenden TPJ, et al, © 2014 with permission from BMJ Publishing Group Ltd.

REFERENCE

Wolfenden TPJ, et al. BMJ Case Rep. 2014;2014:bcr2013203294.

Radiograph of gouty arthropathy and bone erosion in hipRadiograph of gouty arthropathy and bone erosion in hipRadiograph of gouty arthropathy and bone erosion in hip

11/11

(69-year-old female) Radiographs of pelvis revealing intra-articular and para-articular bone erosions. Based on laboratory and radiographic findings, a diagnosis of uncommon axial gouty arthropathy was made (white arrows)

Reproduced with permission of The Foundation Acta Radiologica, from Spinal and sacroiliac gouty arthritis: report of a case and review of the literature, Cardoso FN, et al, 3, 8, © 2014; permission conveyed through Copyright Clearance Center, Inc.

REFERENCE

Cardoso FN, et al. Acta Radiol Short Rep. 2014;3:1-5.

Understanding Gout

Negatively birefringent crystal image (purple) used with permission from Park JJ, et al. BMJ Open. 2014;4(7):e005308.

Myocyte inclusions in the myocardium image used with permission from Frustaci A, et al. Ann Intern Med. 2020;172(5):363-365.

Kidney autopsy image used with permission from Nickeleit V, Mihatsh MJ. Nephrol Dial Transplant. 1997;12(9):1832-1838.

Spinal DECT scan used with permission from Wang JX, et al. BMC Rheumatol. 2020;4:22.

Fundoscopic photograph used with permission from Jiang Y, et al. BMC Ophthalmol. 2018;18(1):11.

Skin image used with permission from Pattanaprichakul P, et al. Dermatol Pract Concept. 2014;4(4):33-35.

  1. Edwards NL. Primer on the Rheumatic Diseases. 13th ed. Springer;2008:241-262.  

  2. Choi HK, et al. Ann Rheum Dis. 2009;68:1609-1612.

  3. Doghramji PP, et al. Postgrad Med. 2012;124:98-109.