TOPHI CREATE AN IMBALANCE IN THE BONE REMODELING PROCESS THAT CAN CAUSE BONE EROSIONS1-3

Over the last decade, Professor Nicola Dalbeth, MD has published multiple papers featuring her industry-leading research on bone erosion and joint damage in gout. Using advanced imaging techniques like dual-energy computed tomography (DECT) scans, Professor Nicola Dalbeth, MD’s research has shown a clear correlation between urate deposition and bone erosion.4

Professor Nicola Dalbeth, MD
Professor Nicola Dalbeth, MD
Auckland, New Zealand

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BOTH LARGE AND SMALL TOPHI CAN CAUSE JOINT DAMAGE1,5-8

Computed tomography scans of hands (serial axial view) from Professor Nicola Dalbeth, MD’s study show areas of bone erosion with radiographic erosion scores of 5 caused by both large and small tophi.1

Serial axial view of hands Large tophus Bone erosion (radiographic erosion score of 5)
Serial axial view of fingers Small tophus Bone erosion (radiographic erosion score of 5)

Tophi, even if they’re not acutely inflamed and causing severe pain at that very moment, have a number of really important consequences for patients.

– PROFESSOR NICOLA DALBETH, MD

Images adapted with permission from Dalbeth N. Ann Rheum Dis. 2009;68(8):1290-1295.1

IN ADDITION TO BONE EROSION, TOPHI CAN LEAD TO FOCAL, POTENTIALLY LONG-TERM LOSS OF CARTILAGE9

In a study of more than 229 tophus sites, readers found a correlation between tophus size and cartilage abnormalities.9*

*P<0.005
Image adapted with permission from Popovich I, et al. Skeletal Radiol. 2014;43(7):917-924.9

Cartilage loss really occurs at the site of the tophus, rather than more diffusely within the entire joint.

– PROFESSOR NICOLA DALBETH, MD

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Additional resources

AMERICAN COLLEGE OF RHEUMATOLOGY (ACR) GUIDELINES FOR MANAGEMENT OF GOUT

AMERICAN COLLEGE OF RHEUMATOLOGY (ACR) GUIDELINES FOR MANAGEMENT OF GOUT
Is your sUA goal low enough to effectively reduce the signs and symptoms of gout and resolve tophi? Review the 2012 ACR guidelines to see if your gout treatment goals line up with industry recommendations.

ENHANCED OSTEOCLASTOGENESIS IN PATIENTS WITH TOPHACEOUS GOUT

ENHANCED OSTEOCLASTOGENESIS IN PATIENTS WITH TOPHACEOUS GOUT
To better understand the mechanisms behind bone erosion in gout, Professor Nicola Dalbeth, MD and her team examined the relationship between increased numbers of osteoclasts at erosion sites and the presence of urate crystals.

CELLULAR CHARACTERIZATION OF THE GOUTY TOPHUS: A QUANTITATIVE ANALYSIS

CELLULAR CHARACTERIZATION OF THE GOUTY TOPHUS: A QUANTITATIVE ANALYSIS
Professor Nicola Dalbeth, MD’s 2010 article in Arthritis & Rheumatology details her team’s study of the cellular architecture of tophi, and how the cells present in the corona and fibrovascular zones of a tophus may contribute to a cycle of chronic inflammation.

TAKE A DEEPER LOOK AT GOUT

View a comprehensive collection of curated medical images to see the full scope of damage that tophi can cause.

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WHAT YOU CAN DO

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References

  1. Dalbeth N, et al. Ann Rheum Dis. 2009;68(8):1290-1295.
  2. Schett G, et al. RMD Open. 2015 Aug 15;1(suppl 1):e000046.
  3. McQueen FM, et al. Rheumatology (Oxford). 2014;53(1):95-103.
  4. Dalbeth N, et al. Ann Rheum Dis. 2015;74:1030-1036.
  5. Doghramji PP, et al. Postgrad Med. 2012;124(6):98-109.
  6. Yu KH, et al. Rheumatology (Oxford). 2004;43(2):191-194.
  7. McQueen FM, et al. Rheumatology (Oxford). 2014;53(1):95-103.
  8. Desai MA, et al. RadioGraphics. 2011;31(5):1365-1375.
  9. Popovich I, et al. Skeletal Radiol. 2014;43(7):917-924.