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Diffuse idiopathic skeletal hyperostosis and new bone formation in male gouty subjects. A radiologic study
Insights
Gout patients frequently exhibit signs of diffuse idiopathic skeletal hyperostosis (DISH) and new bone formation. These skeletal changes may be linked to a common metabolic factor, potentially hyperinsulinaemia.
Area of Science:
- Rheumatology
- Orthopedics
- Metabolic Diseases
Background:
- Gout is a metabolic condition characterized by hyperuricemia.
- Diffuse idiopathic skeletal hyperostosis (DISH) involves widespread bone proliferation.
Purpose of the Study:
- To investigate the prevalence of DISH and related skeletal changes in male gout patients.
- To explore potential links between gout, new bone formation, and metabolic factors.
Main Methods:
- Radiographic assessment of 99 male gout patients.
- Evaluation for vertebral hyperostosis and entheseal changes indicative of DISH.
- Analysis of new bone formation in other skeletal regions.
Main Results:
- 43% of gout patients over 45 years old met DISH diagnostic criteria.
- New bone formation was common in various skeletal sites.
- The overhanging margin sign, associated with tophi, appeared in patients with significant new bone formation.
Conclusions:
- A significant association exists between gout and diffuse idiopathic skeletal hyperostosis.
- Radiographic features of gout may be influenced by an underlying tendency for new bone formation.
- Hyperinsulinaemia is proposed as a potential shared metabolic factor linking gout and hyperostosis.
Abstract:
Ninety-nine males with gout were identified and their radiographs examined for features of vertebral hyperostosis and entheseal changes (diffuse idiopathic skeletal hyperostosis, DISH). Of patients over the age of 45 years 43% fulfilled criteria for diagnosis of DISH. New bone formation in other regions of the skeleton was also common. The overhanging margin sign, seen in well developed tophi, was noted only in patients with prominent new bone formation elsewhere in their skeleton. Some of the radiologic manifestations of gout may be modified by a co-existent tendency, in these patients, to form new bone. It is suggested that a common metabolic factor, possibly hyperinsulinaemia, underlies the association of gout and hyperostosis.