Multi-joint Musculoskeletal Ultrasonic Manifestations And Laboratory Indicators In Acute Attack Of Gouty Arthritis

Part one Multi-joint Scanning of High Frequency Ultrasound in the Diagnosis and Treatment of Gouty ArthritisObjective:Tostudy multi-joint scanning of highfrequency ultrasound in gouty arthritis,and to explore the value of musculoskeletal ultrasound in gouty arthritis patients.Methods:A total of 129 patients with gout admitted to the department of rheumatology of our hospital were included fromSeptember 2018 to June 2019 in this study.We collected the basic clinical data of all patients.Multiple joint(including bilateral knee,ankle and first metatarsophalangeal joints)were performed with Musculoskeletal Ultrasound(MSUS)on all patients.The number and distribution of joints withdouble contour signs(DCs),hyper-echoic aggregates,tophus and bone erosion were calculated.The 129 patients were further divided into two groups according to the current clinical criteria of joint redness and swelling,namely acute attack stage and non-acute attack stage.And the differences of ultrasonic manifestations between acute and non-acute gout patients were analyzed.Result:A total of 774 joint accepted Musculoskeletal ultrasonography,punctate hyper-echo in synovial membrane(351 joints)is the most common,followed by synovial hyperplasia(342 joints),aggregates(334 joints),double contour signs(277 joints),effusion with punctate hyper-echo(216 joints),tophus(200 joints),bone erosion(174 joints)was relatively rare.Except insofar as joint effusion with punctate hyper-echo,which is common in the knee joint,the first metatarsophorangeal joint is the most common with punctatehyper-echo in synovial membrane,synovial hyperplasia hyper-echoic aggregates,double contour signs,tophus and bone erosion.The number of double contour signs in knee joint is second only to the first metatarsophalangeal joint.The average serum uric acid level in patients with acute attack was lower than that in patients without acute attack,and the difference was statistically significant(P<0.05).Synovial hyperplasia was observed in both acute and non-acute episode groups,and the number of joints with synovial hyperplasia in acute episode patients was higher than that in non-acute episode patients,with statistically significant difference(P<0.05).Further powerdoppler imaging(PDI)confirmed that the blood flow signals in the synovial membrane of patients with acute seizure were richer than those of patients without acute seizure,and the blood flow rating was higher,the difference was statistically significant(P<0.05).The number of joints with tophus and bone erosion in patients with non-acute attack was higher than that in patients with acute attack,and the difference was statistically significant(P<0.05).And there was no significant difference of effusion with punctate hyper-echo,punctate hyper-echo in synovial membrane,aggregates and double contour signs between the two groups(P>0.05).Conclusion:Although the acute onset of gouty arthritis is common in single joint,monosodium urate crystals can be deposited in and out of multiple joints early.synovial hyperplasia was found in multiple joint of patients with gouty arthritis in both acute and non-acute phases,but the synovial blood flow score in acute onset was higher than that in non-acute onset.Musculoskeletal Ultrasound multi-joint examination can assist in early diagnosis of atypical site gout,search for evidence ofuratedeposition inasymptomatic high uric acid patients,and also can evaluate the active degree of joint inflammation in patients,so as to better evaluate the overall condition of patients.Part two Study on the correlation between laboratory indexes and ultrasonic manifestations of dysphoric arthritisObjective:The inflammatory process of acute onset of gouty arthritis often leads to abnormal laboratory inflammatory indicators.It is found that not only c-reactive protein(CRP),erythrocyte sedimentation rate(ESR),but fibrinogen is increased in patients with gout.And the relationship between fibrinogen and acute onset of gout remains unclear.The purpose of this section was to compare the changes of serum uric acid level in patients with acute and non-acute episodes,and investigate the changes and consistency of laboratory inflammatory indicators ESR,CRP and fibrinogen in patients with gouty arthritis during acute onset and non-acute onset.Method:A total of 129 patients including 85 patients with acute onset of gouty arthritis and 44 patients in remission were included.The basic clinical conditions of the patients in the two groups were collected,and the levels of ESR,CRP,fibrinogen and serum uric acid in the two groups were detected and recorded.Result:Fibrinogen in patients with acute gout was consistent with ESR and CRP,both higher than those in patients without acute gout,the difference was statistically significant(P<0.05).The Area Under Curve(AUC)(0.844)of fibrinogen in patients with acute gout was larger than CRP,ESR(0.653,0.714).The serum uric acid level in patients with acute attack was lower than that in patients with remission,and the difference was statistically significant(P<0.05).Conclusion:The serum uric acid level in patients with acute gout is lower than that in patients with remission.Fluctuations in serum uric acid levels may be involved in acute gout episodes.Fibrinogen elevation is consistent with acute onset of gout,which may be used to predict or evaluate acute onset of gout arthritis.