THE EXTENT OF TOPHUS-INDUCED JOINT DAMAGE
WITH PROFESSOR NICOLA DALBETH, MD
One of the really important consequences of tophi, and intra-articulate tophi in particular, is that they contribute to joint damage, particularly by an erosion, and also focal cartilage loss.
The cartilage loss is really different to what we see in rheumatoid arthritis and psoriatic arthritis, where the cartilage loss is much more diffuse.
Whereas in gout, if we look at the MRI scans and if we look at MRI scans specifically targeting cartilage, we see much more focal cartilage loss. The cartilage loss really occurs at the site of the tophus, rather than more diffusely within the entire joint.
We also looked and compared the size of the erosion and the size of the intraosseous tophus, and again demonstrated a very close relationship between those 2 structures.
Of course, we've gone on and looked at this in a number of other ways with imaging studies, as well. And again, in those studies, what we see is that the main predictor for developing bone erosion over time is the development of tophi.
What we really need now, I think, are large, long-term studies to actually look at whether driving the serum urate very low can have a benefit on bone erosion.
If we can get the serum urate low enough, we may be able to actually not only prevent progression, but potentially actually see healing of erosion in a way that we very rarely see in other inflammatory diseases.