| Objectives To observe the changes of joint ultrasound sonograms over time during uric acid lowering therapy of gout patients by using high-frequency musculoskeletal ultrasound.To explore the time when the signs of urate deposition in the joints dissolve and disappear,to analyze the correlation between changes in the signs of urate deposition in the joints and clinical characteristics,compliance,and serum uric acid levels.Methods From September 2018 to February 2020,90 gout patients were selected in strict accordance with the diagnostic criteria of American Rheumatology Association,the inclusion criteria and exclusion criteria of this study.The time of the first diagnosis of gout was taken as the observation starting point,i.e.the follow-up baseline,the baseline investigation and collection of relevant clinical data,the biochemical examination of serum uric acid in the laboratory and examination of high-frequency musculoskeletal ultrasound(including first metatarsophalangeal joint,ankle joint and knee joint),and the ultrasonic signs such as double contour sign,tophi and blood flow signal around the synovium were observed under the ultrasound.The patients were treated by senior doctors of Rheumatology and Immunology Department.In the process of uric acid lowering therapy,that is,during the follow-up,the serum uric acid was rechecked every other month,and the high-frequency musculoskeletal ultrasound every two months.The follow-up time was 14 months,and the last ultrasound examination was the end point.The comparison of clinical data and serum uric acid level between the disappearance group and the non disappearance group,as well as the comparison of disappearance rate and decrease of gouty stone in the groups with different serum uric acid standard level at the end of followup,the measurement data were in the mean ± standard deviation.Student's t test is used for comparison;the categorical data is expressed in percentage(%),chi square test and Fisher exact probability method are used for comparison;Friedman M test is used for comparison of blood flow classification;comparison between the two groups was corrected by bonferrioni;the size of tophi with time in the process of uric acid lowering therapy were analyzed by ANOVA of repeated measurement data;the correlation between the size of tophi and the change of serum uric acid level was examined by person correlation test.The inspection level ? is 0.05.Results Patients with other arthritis,fractures,and loss of follow-up during treatment were excluded from the 90 patients,and 80 patients were included in the study.There were 71 patients with double contour sign in the baseline joint region.After 14 months of follow-up,22 patients with double contour sign disappeared and 49 patients without double contour sign disappeared.Tophus were found in 38 joints of 32 patients at baseline.After 14 months of follow-up,the volume of Tophus decreased.1 There was no significant difference in BMI,diabetes,dyslipidemia,hypertension and other metabolic complications between the disappearance group(22 cases)and the non disappearance group(49 cases)after 14 months of treatment(P>0.05).The disappeared double contour sign group had a longer course of disease,lower baseline serum uric acid level,greater reduction of serum uric acid level at the end of follow-up,and better patient compliance than the nondisappeared group,with statistically significant differences(P<0.05).2 The median time of disappearance of double contour sign was 8 months.3 After uric acid lowering therapy,there was no significant difference(P>0.05)between the volume of tophus measured at the 2nd,4th,6th,8th and 10 th month of follow-up.Measurements decreased significantly at 12 months compared to baseline,and further decreased at 14 months,with statistically significant differences(P<0.05).4 At 14 months after uric acid lowering therapy,there was a significant positive correlation between the decrease of the volume of tophus and the decrease of the SUA level(r = 0.89,P<0.05);there was a significant negative correlation between the decrease of the volume of tophus and the final SUA level(r =-0.98,P<0.05).5 After 14 months of treatment,there were significant differences in the changes of ultrasonic signs(including the reduction in the volume of tophus and the disappearance rate of double contour sign)in the final serum uric acid levels of the patients in the extremely low group(<300 ?mol/L),the low group(300?360 ?mol/L)and the high group(>360 ?mol/L)(P<0.05).In the patients with extremely low serum uric acid level,the largest decrease of tophus volume(P<0.05),the largest disappearance rate of double contour sign(P<0.05).6 There was significant difference in the joint blood flow signal grading of 80 patients at baseline,2 months and 12 months after uric acid lowering therapy(?2 = 37.440,P<0.05).After 2 months of treatment,the blood flow signal around the joint synovium increased significantly.At 14 months,the blood flow signal was significantly decreased compared with that at 2 months and the base line(P<0.05)At 14 months after treatments,more than half of the patients(53 / 80)had no loss of peripheral blood flow signals,48.8%(39 / 80)of the patients showed grade 1 blood flow signal in the joint,that is.Only 33.8%(27 / 80)of the patients had peripheral blood flow signal disappeared.Conclusions 1 High-frequency musculoskeletal ultrasound can be used to observe the dissolution ang disappearance of urate crystal(Including the disappearance of double counter sign and the reduction of tophi)in the joint during the treatment of gout patients.It can provide a safe and noninvasive imaging method for the evaluation of gout patients' curative effect and follow-up.It should be further popularized and applied.2 During the course of uric acid lowering therapy in gout patients,the dissolution of urate crystal under ultrasound is related to the baseline level of serum uric acid,the decreasing situation and the final standard level,the course of disease and compliance of patients.The shorter the course of the disease,the lower the blood uric acid level,the better the patient compliance,the more conducive to the disappearance of the double counter sign and the reduction of tophi.3 During the course of uric acid lowering therapy in gout patients,there is a timedependent dissolution of urate crystal in the joint.During the course of decreasing uric acid in gout patients,the serum uric acid was maintained at about 360 ?mol/L,and the median time of for the disappearance of double counter sign was 8 months,and the time of volume of tophus decreased significantly in the 12 th month.4 It is necessary to prevent gout recurrence at the beginning of uric acid lowering therapy in patients with gout.5 After uric acid lowering therapy in patients with gout,there is a long period of potential subclinical synovitis,which has some implications for the prognosis of patients.After 14 months of treatment,the blood flow signals in the joints of most patients were still present.Figure4;Table8;Reference 127... |
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