The Differential Diagnsosis Of Musculoskeletal Ultrasound In Metatarsophalangeal Joint Erosions In Rheumatoid And Gouty Arthritis

Objective:The aim of this study was to explore the value of diagnosis and differential diagnosis of bone erosion in patients with rheumatoid arthritis(RA)and gouty arthritis(GA)by musculoskeletal ultrasound.Methods:Retrospectively analyzed the ultrasonographic features of the bilateral first to fifth metatarsophalangeal joint(MTPJ)bone erosions in patients with RA(n=43)and GA(n=52)in our hospital from January 2015 to December 2017.The ultrasound images were read for the direct presences of location,morphology,border,color flow signal and indirect presences of tophus,double contour sign,hyperechoic foci in synovium or effusion and synovial proliferation,the direct and indirect presences were compared between these two groups.Results:Direct signs:(1)Bone erosions in patients with RA were found in the first MTP(MTP1)joint(2/43,4.65%),the second MTP(MTP2)joint(4/43,9.30%),the third MTP(MTP3)joint(2/43,4.65%),the forth MTP(MTP4)joint(3/43,7.14%),and the fifth MTP(MTP5)joint(43/43,100%);bone erosions in patients with GA were found in the first MTP(MTP1)joint(52/52,100%),the second MTP(MTP2)joint(2/52,3.85%),the third MTP(MTP3)joint(3/52,5.77%),the forth MTP(MTP4)joint(2/52,3.85%),and the fifth MTP(MTP5)joint(2/52,3.85%),the differences were statistically significant(P<0.001).(2)In patients with RA,the bone erosions were showed as poor-defined border(40/43,93.0%),rounded shape(39/43,90.7%);while in patients with GA,the bone erosions were showed as well-defined border(39/52,75%),rounded or oval-shaped(32/52,61.5%vs 20/52,38.5%),the differences were statistically significant(P<0.001,respectively).Indirect signs:CDThe indirect presences of tophus(33/52,63.5%),double contour sign(21/52,40.4%),hyperechoic foci in synovium or effusion(23/52,44.2%)were only found in GA,the differences were statistically significant(P<0.001,respectively).?synovial proliferation(38/43,88.4%)was observed more frequently in patients with RA,while in patients with GA,fewer synovial proliferation(10/52,19.2%)was observed,the differences were statistically significant(?2=42.29,P<0.001).Conclusion:The characteristics of bone erosion in patients with RA and GA,with the direct presences of border,shape,location and the indirect presences of hyperechoic foci in synovium or effusion,tophus,double contour sign and synovial proliferation,could be help to diagnosis and differential diagnosis.