Clinical Application Of Musculoskeletal Ultrasound In The Assessment Of Urate Load Of MTP1 In Gouty Arthritis And In Monitoring The Therapeutic Efficacy Of Gout

Chapter One:Assessment of MTP1 urate load in patients with gouty arthritis:based on the semi-quantitative ultrasound scoring system for gout lesions developed by the OMERACT Working Group in 2021Objective:To assess the MTP1 urate load in patients with gout based on the SQUS of OMERACT gout lesions and analyze the factors that might influence the urate load and the risk factors for the development of urate deposits.Methods:A total of 192 patients with gouty arthritis,who met the 1977 ACR gout classification criteria,were included in this study,and ultrasonography of the lower limb joints was performed for all patients.Gout lesions(Tophus,DCS,aggregates)were identified.The MTP1 urate load was assessed according to the semi-quantitative ultrasound scoring system for gout lesions(DCS:score 0-3;Tophus:score 0-3;Aggregates:score 0-3),the factors influencing the urate load were analyzed,and the independent risk factors for the development of urate deposits were evaluated.Results:The multiple linear regression analysis of disease duration,age,SUA and SQUS(MTP1)were all statistically significant,with regression coefficients of 0.18,0.05 and 0.03 respectively,creating a regression model SQUS(MTP1)=-13.29+0.18*disease duration+0.05*age+0.03*SUA.A binary logistic regression of SUA(OR=1.010)with the SQUS(MTP1)subgroup was statistically significant and SUA was an independent risk factor for the development of urate deposition in MTP1 in patients with gout.Conclusion:The SQUS developed by the OMERACT Working Group in 2021 can be used to effectively assess the MTP1 urate load in patients with gouty arthritis and predict the severity of gouty lesions in MTP1 based on the duration of gout,age,and SUA.Moreover,SUA was found to be an independent risk factor for urate deposition in MTP1 in patients with gout.Chapter Two:Musculoskeletal ultrasound in monitoring the efficacy of gouty arthritis:a prospective study based on tophus and double contour signObjective:The aim of this study was to observe the changes in tophus size(area,long diameter,short diameter)and the semi-quantitative ultrasound scoring system(SQUS)of the double contour sign(DCS)during a 1-year period of urate-lowering therapy(ULT)in gout patients in order to explore the value of musculoskeletal ultrasound in monitoring the efficacy of ULT in gout.Methods:Patients with gouty arthritis who met the 1977 American College of Rheumatology(ACR)gout classification criteria and exclusion criteria were included.All patients were treated with ULT and ultrasonography of the lower limb joints was performed on all patients before the start of ULT(MO),3 months after ULT(M3),6 months(M6)and 12 months(M12)to observe the changes in DCS,tophus at each ULT-time point.In this study,all enrolled patients were divided into two groups(ULT efficacy achieved group and ULT efficacy not achieved group)based on the outcomes of ULT efficacy.The study examined whether the differences in tophus size and DCS-SQUS within each of the three groups(ULT efficacy ungrouped,ULT efficacy achieved group,and ULT efficacy not achieved group)were statistically significant between ULT time points to explore whether musculoskeletal ultrasound could observe changes in tophi and DCS in ULT.Results:For tophus,the ULT efficacy ungroup:the area,long diameter and short diameter of tophus tended to decrease between the ULT-timepoints,and the differences between M12 and M0,M3 and M6 were statistically significant(P<0.05)for both the area and long diameter of tophus,while none of the differences between the remaining timepoints were statistically significant(P>0.05);the difference in the short diameter of the tophus was not statistically significant(P>0.05)between M0 and M3,while the differences between the remaining time points were statistically significant(P<0.05).The ULT efficacy achieved group:the area,long diameter and short diameter of the tophus tended to decrease between ULT-time points;the difference between the area and short diameter of the tophus was not statistically significant(P>0.05)between M0 and M3,while the difference between the remaining time points was statistically significant(P<0.05);the differences of the long diameter of tophus between M12 and M0,M3 and M6 were all statistically significant(P<0.05),while none of the differences between the remaining time points were statistically significant(P>0.05).The ULT efficacy not achieved group,the area and long diameter of the tophi tended to increase slightly between the ULT time points,while the short diameter of the tophus did not change significantly between the ULT time points;the differences between the area,long diameter and short diameter of the tophi were not statistically significant(P>0.05).For DCS,the mean DCS-SQUS scores in all groups tended to decrease between the ULT-timepoints,and the change was more pronounced in the ULT efficacy achieved group than in the ULT efficacy not achieved group.The differences in DCS-SQUS scores between the ULT-timepoints were statistically significant(P<0.05)in both the ULT efficacy ungroup and the ULT efficacy achieved group;the differences in DCS-SQUS scores in the ULT efficacy not achieved group were statistically significant(P<0.05)between MO vs M6,M12,M3 vs M12,and M6 vs M12,while none of the differences between the remaining ULT-time points were statistically significant(P>0.05).Conclusion:During ULT,significant changes in both tophus and DCS were observed on musculoskeletal ultrasound for the ULT efficacy achieved groups,whereas for the ULT efficacy not achieved group,no significant changes in tophaceous were observed on sonograms,while changes in DCS were observed on sonograms.The sensitivity of the efficacy monitoring was in descending order of DCS,short diameter of the tophus,area of the tophus and long diameter of the tophus.Musculoskeletal ultrasound can be a useful tool for monitoring the efficacy of ULT.