The characteristic radiographic hallmarks of chronic
gouty arthritis are the presence of macroscopic tophi and erosions with overhanging edges and relative preservation of the joint space. In recent years there has been more insight into the processes underlying the development of bone erosions in
gouty arthritis. This review discusses the mechanical, pathological, cellular and
immunological factors that may have a role in the pathogenesis of bone erosions in
gouty arthritis. It highlights the evidence suggesting that
monosodium urate crystal deposition is associated with the presence of underlying
osteoarthritis and the important role of osteoclasts and the receptor for activation of nuclear factor κ B (RANK) and
RANK ligand (RANK-RANKL) pathway in the pathogenesis of gouty erosions.
Gouty arthritis is primarily driven by
interleukin 1β (IL-1β). IL-1β has been implicated in bone destruction and erosions in other inflammatory arthridities. Thus, future
IL-1 inhibitors may prevent and treat erosion formation due to tophaceous
gouty arthritis. This review discusses imaging modalities and highlights ultrasongraphic evidence suggesting a significant relationship between the presence of the gouty tophus and bone erosions as well as the frequent presence of persistent low-grade
inflammation in asymptomatic chronic tophaceous
gouty arthritis on high-resolution ultrasonography. It is the tophus eroding the underlying bone that is pivotal for the development of bone erosions in
gouty arthritis.