GOUTY ARTHRITIS IN A PATIENT WITH PSORIASIS

 

Zamyshevskaya M.A., Zavadovskaya V.D., Dongak D.-S.A., Udodov V.D., Kim T.-V.

 

Siberian State Medical University. Tomsk, Russia.

P

urpose. To demonstrate the possibilities of modern radiological methods (dual-energy computed tomography (DECT), ultrasound (US)) in the detection and evaluation of gouty arthritis in a patient with manifestations of psoriasis.

Material and methods. The article presents a clinical observation of a patient complaining of pain in the wrist, metacarpophalangeal, interphalangeal joints of the hands and the formation of localized areas of compaction on the hands and feet. In addition to clinical and laboratory methods, the patient was referred to the radiological diagnostics department to establish a correct diagnosis. The following procedures were performed: radiography, ultrasound examination (US), dual-energy computed tomography (DECT).

Results. The article describes the possibilities of using modern radiological diagnostic methods (DECT, ultrasound) in gouty arthritis, including for the differential diagnosis of psoriatic arthropathy and gouty arthritis. According to the data of the applied medical imaging methods, the presence of gouty arthritis was most likely diagnosed, which was subsequently verified.

Discussion. Gouty arthritis is a common form of crystalline arthropathy. Differential diagnostics of gout at an early stage may present certain difficulties based on both laboratory and instrumental diagnostic methods. The main symptom that forces diagnostic search is hyperuricemia, which often accompanies psoriatic arthropathy and is often associated with the activity of skin manifestations. Although joint aspiration is the "gold standard" of diagnostics, this method is a relatively invasive procedure with a risk of complications in the form of an infectious or inflammatory process, damage to intra-articular structures, and hemorrhage into the joint cavity. In addition, aspiration of intra-articular fluid may be inaccessible and inaccurate in conditions of a small volume of joint effusion. Thus, it becomes obvious that in certain cases laboratory methods cannot always confirm the diagnosis of gout both due to their insufficient diagnostic efficiency and due to technical difficulties. Therefore, non-invasive instrumental research methods play a significant role in the diagnosis of gouty arthritis, including all modalities of radiological diagnostics – radiography, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) (paragraph B of the clinical recommendations of the Ministry of Health of the Russian Federation, 2018).

Conclusion. The use of modern, highly informative radiological methods (DECT, ultrasound) is an integral step in the diagnosis of gouty arthritis, which makes it possible to identify typical radiosemiotics, assess the localization, prevalence of the pathological process, which, in the future, determines the tactics of managing the patient, in accordance with the established diagnosis.

 

Keywords: gouty arthritis, tofus, sodium monourate crystal, psoriasis, ultrasound, dual-energy computed tomography.

 

Corresponding author: Zamyshevskaya M.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Zamyshevskaya M.A., Zavadovskaya V.D., Dongak D.-S.A., Udodov V.D., Kim T.-V. Gouty arthritis in a patient with psoriasis. REJR 2025; 15(3):280-290. DOI: 10.21569/2222-7415-2025-15-3-280-290.

Received: 04.12.24 Accepted: 30.10.25