Evaluation of Tophaceous Gout by FDG-PET/CT and Bone Scan

We report the case of a 76 year old male patient with a clinical history of gouty arthritis and multiple enormous gouty tophus for decades. Medical history as well presented prostate cancer, arterial hypertension and chronic atrial fibrillation. Hospitalisation became necessary in October 2011 due to duodenal ulcer. At this time no specific medication for gout was taken. Serum urine acid and CRP were in the normal range. Bone scan showed multifocal arthritis in small finger joints of both hands, activation was present only in the left PIP joint of digit IV. The diphosphonate tracer was not captured by the subcutaneous tophus of the right hand. Additional evaluation of inflammatory processes by FDG-PET/CT was done in succession, both tophi presented augmented glucose metabolism with an SUV of about 2. After efficient treatment with proton pump inhibitors and healing of ulcer disease verified by endoscopic control examination, medication for gout with allopurinol and diclofenac was reinitialised. We recommend to consider the use of nuclear medicine imaging in gouty arthritis and tophus additionally to radiological methods or via hybrid imaging to visualise inflammation in joints and further involved tissue.