| Background:The ultrasond(US)manifestations of gouty arthritis are complex and diverse.Comprehensive evaluation of positive signs of lower limb joints is of great importance for early diagnosis.Knowing about the relationship between different clinical characteristics and US features may deepen the cognition of the disease and predict the prognosis.Objective:This observational cross-sectional study evaluated the distribution of specific and non-specific US features of lower limb joints and the risk factors of specific features in gout patients.Methods:We examined 588 joints including the bilateral knee,ankle,and first metatarsophalangeal(MTP1)joints in 98 clinically confirmed gout patients by ultrasound during July to December in 2017.The distribution of double-contour(DC),tophus,aggregates,synovitis,effusion and erosion in different joint(knee ankle and MTP1),course(<2years and?2 years),age(<50 years old and?50 years old)and serum urate level(<420,420-600,?600?mol/L)groups were investigated by Cochran's Q and?~2 test.The risk factors of tophus and DC were analyzed using logistic regression method.Results:(1)In different joint groups,DC was most commonly observed in the knee28.6%while lowest in the ankle 11.2%(Q=10.4,P=0.005).Tophus,aggregates,synovitis,and erosion were mostly detected in the MTP1 joint(22.5%,Q=24.2,P<0.001);(26.5%,Q=9.2,P=0.01);(42.9%,Q=13.6,P=0.001);(33.7%,Q=19.5,P<0.001),respectively.(2)The prevalence rates of DC,tophus,and erosion in patients with a longer course were significantly higher(51.5%vs 28.1%,?~2=4.79,P=0.029);(34.8%vs 6.3%,?~2=9.28,P=0.002);(56.1%vs 18.8%,?~2=12.18,P<0.001),respectively.(3)Older patients had more detectable tophus and erosion than younger patients.(34.6%vs 15.2%,?~2=4.83,P=0.028);(55.8%vs 32.6%,?~2=5.29,P=0.021).(4)There were no significant differences in prevalence rates of DC,tophus and aggregate between different serum urate level groups(?~2=4.19,P=0.123;?~2=5.01,P=0.08;?~2=1.51,P=0.469).(5)Patients of older age(OR=3.83,95%CI:1.27-11.48),with frequent attacks(OR=3.80,95%CI:1.10-13.15),and with longer course(OR=6.52,95%CI:1.37-30.96)had higher risks of tophus.The course of disease(OR=17.16,95%CI:4.52-65.13)and frequency of attack(OR=3.0,95%CI:1.02-8.83)were also important risk factors of the formation of DC sign.Conclusions:(1)Most specific and nonspecific signs were detected by US in the MTP1,except that DC was most commonly observed in the knee.To help diagnosis,we should lay stress on searching intercondylar cartilage of the femur and MTP1 for more specific signs based on a comprehensive scan of the lower limb joints.(2)Although hyperuricemia is essential for the diagnosis of gout,the value of serum urate acid at a specific time point cannot predict the DC sign and tophus independently.(3)Patients of older age,with frequent attacks and longer course may suffer higher risks for tophus which causes joint damage.The long course of disease and frequent attacks were also important risk factors of the formation of DC sign.Comprehensive assessment of the lower limbs,particularly the knee and MTP1,can significantly help diagnosis of gout.Background: The monitoring of treat-to-target(T2T)urate-lowering therapy(ULT)for gouty arthritis is crucial for the assessing treatment response and determining treatment plans.Ultrasound(US)is an effective imaging tool for judging therapeutic endpoints and predicting prognosis.Objective: To observe the changes in three outcome domains(urate deposition,joint inflammation and bone erosion)in the treatment of gouty arthritis with ULT within 1 year,evaluate the effect of target treatment and analyse the relationships between clinical factors and US features,providing imaging evidence for clinical remission.Methods: The specific and nonspecific signs of the bilateral knee,ankle and first metatarsophalangeal(MTP1)joints were evaluated by US before and after 3,6 and 12 months of treatment.(1)Urate deposition was assessed by the maximum long and short axis diameters of the tophus and dichotomous data of the double-contour(DC)sign and aggregates.After each follow-up,the most obvious lesions were selected for repeated observation.Effective clearance rate was defined as the proportion of subjects with both the long and short axes of tophus decreased by 20% or with the DC sign or aggregates changing from presence to absence before and after ULT.The clearance rates of these three signs in different time groups were compared.The correlations between serum uric acid(s UA)levels and disease course with tophi size were analysed.(2)A composite power Doppler ultrasound(PDUS)synovitis score,developed by the Outcome Measures in Rheumatology–European League Against Rheumatism(OMERACT–EULAR)-Ultrasound Task Force,was used to evaluate individual joints.The composite PDUS score of each joint was added into a Global OMERACT–EULAR Synovitis Score(GLOESS)for these three paired joints to observe the remission and recurrence of inflammation.(3)Bone destruction was scored on a semiquantitative scale(0–3)at each time point and compared the differences.Results: Seventy-nine patients completed the 1-year treatment period.(1)The differences between the long and short axis diameters of tophus at different time points were significant(F [1.616,42.003] =7.41,P=0.003;F [2.187,56.855] =10.95,P<0.001).Compared with those at baseline and month 3,the long axis values at month 12 decreased by 0.22 cm(P=0.018)and 0.17 cm(P=0.02),respectively.The short axis values at month3,6 and 12 decreased by 0.072 cm(P=0.038),0.111 cm(P=0.003)and 0.156 cm(P=0.02),respectively,compared with the baseline values.(2)There was a positive correlation between the decrease in s UA levels and the long axis values(r=0.335,P=0.043),however,no correlation was found between the decrease in s UA levels and the short axis values(r=0.287,P=0.085).There was no significant correlation between disease duration and the reduction in long and short axis values.(3)For tophus,there was no significant difference in the clearance rate between different time groups(?~2=1.76,P=0.392),while for DC sign and aggregates,significant differences were found by paired comparison(?~2=21.48,P<0.001;?~2=7.75,P=0.018).the DC sign began to disappearance at 6 months(clearance rate,19.1%),however,the aggregates disappeared as early as 3 months and the effective clearance rate was higher at 12 months than at 3 months(32.2% vs 7%,P=0.01).(4)The GLOESS at each time point was significantly different(?~2=32.316,P<0.001).Paired comparisons suggested that the values at baseline(range 0-11,median 3)were significantly higher than those at 6 months(range 0-10,median 1)(P=0.004)and 12 months(range 0-6,median 1)(P<0.001).(5)Bone erosion had not improved after 1 year of treatment(Z=-1.633,P=0.102).Conclusion:(1)The decrease in s UA levels was not completely parallel to the decrease in tophus size.The long axis value of tophi was more important than the short axis in evaluating of the effect of ULT.The disappearance time of aggregates was the earliest,followed by the DC sign;tophi was the slowest to respond to treatment.Therefore,ULT with different intensities should be formulated according to different crystal deposition conditions under US assessment.(2)Using high-frequency US,subclinical inflammation can be sensitively observed and gradually controlled after 6 months of therapy.(3)Bone damage of the joint in gout patients was relatively stable within 12 months of treatment,and no obvious improvement was detected.Overall,US plays a key role in evaluating of three outcome domains of T2 T therapy... |
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