Evaluation Value Of Shear Wave Elastography Combined With Conventional Ultrasound On The Efficacy Of Febuxostat In The Treatment Of Gouty Arthritis

Objective: This study used shear wave elastography(SWE)and ultrasound to evaluate the efficacy of febuxostat in the treatment of gouty arthritis(GA).The ultrasound signs of the first metatarsophalangeal joint(MTP1)of the feet and the changes in Young’s modulus over time were compared before and after treatment,and the value of SWE combined with ultrasound in the evaluation of the effect of GA lowering uric acid treatment was discussed.Method: In strict accordance with the standards,45 patients with GA who were treated in the Department of Rheumatology and Immunology of the Affiliated Hospital of Inner Mongolia Medical University from November 2019 to April 2020 were selected.Before enrollment,all patients were tested for blood uric acid levels,and two experienced sonographers performed SWE and ultrasound examinations on MTP1 of both feet.After enrollment,all patients were given a regular dose of febuxostat orally to reduce blood uric acid,and were reviewed after 3 and 6 months of treatment.Compare the changes of specific and non-specific signs related to urate crystal deposition on ultrasound images before and after treatment,and use SWE to measure the maximum Young’s modulus(Emax)and average Young’s modulus(Emean)of the synovium,Quantitative assessment of changes in synovial stiffness before and after treatment.Result: 1.Compared with before treatment,blood uric acid value,synovial thickness,intrasynovial blood flow signal level,"dual track sign" level and tophi maximum diameter decreased after 3 and 6 months of treatment,and the differences were statistically significant.(P<0.05).2.The results of SWE examination showed that the Emean and Emax of the synovial membrane were significantly reduced after 3months and 6 months of treatment,and there were significant differences compared with those before treatment(P<0.01).3.The results of correlation analysis showed that the degree of synovial thickness reduction after uric acid-lowering treatment was significantly positively correlated with the degree of blood uric acid level reduction(r=0.768,P<0.01);the degree of reduction in synovial emean and "dual track sign" The reduction of blood uric acid level was positively correlated(r=0.699,r=0.502,P<0.01);the changes in the maximum diameter of tophi and synovial Emax before and after treatment were not significantly correlated with changes in blood uric acid(P>0.05).4.Compared with before treatment(34),the number of joints with tophi was reduced after 3 months(30)and 6 months(23)after treatment,and the difference was not statistically significant(P>0.05).Conclusion: As a new ultrasound examination technology,SWE can perform quantitative analysis on the basis of conventional ultrasound qualitative diagnosis.The combined application of the two can more accurately and comprehensively display the changes in related signs before and after treatment,providing clinicians with an objective basis for treatment.