Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, New Zealand.
BMC Musculoskelet Disord. 2013 Dec 21;14:363. doi: 10.1186/1471-2474-14-363.
Although typically a late feature of gout, tophi may present early in the course of disease. The aim of this study was to identify factors associated with the presence of early tophaceous disease.
People with gout for <10 years were prospectively recruited, and had a comprehensive clinical assessment including examination for subcutaneous tophi. The clinical factors independently associated with the presence and number of tophi were analyzed using regression models.
Of the 290 participants, there were 47 (16.2%) with clinically apparent tophi. In univariate analysis, those with tophi were older, were more frequently taking diuretics and colchicine prophylaxis, and had lower creatinine clearance. The association between the presence of tophi and creatinine clearance was strongest in those with creatinine clearance ≤30 ml/min. In logistic regression analysis, creatinine clearance ≤30 ml/min was associated with the presence of tophi, even after adjusting for ethnicity, corticosteroid use, colchicine use and diuretic use (multivariate adjusted odds ratio 7.0, p = 0.005). Participants with tophi reported higher frequency of gout flares, pain scores, patient global assessment scores, and HAQ scores.
The presence of tophi is associated with more symptomatic disease in people with gout for <10 years. Creatinine clearance is independently associated with early presentation of subcutaneous tophi.
尽管痛风石通常是痛风的晚期特征，但也可能在疾病早期出现。本研究旨在确定与早期痛风石病相关的因素。
前瞻性招募了病程<10 年的痛风患者，并进行了全面的临床评估，包括皮下痛风石检查。使用回归模型分析与痛风石存在和数量相关的临床因素。
在 290 名参与者中，有 47 名（16.2%）存在明显的皮下痛风石。在单因素分析中，有痛风石的患者年龄更大，更频繁地服用利尿剂和秋水仙碱预防药物，且肌酐清除率更低。在肌酐清除率≤30ml/min 的患者中，痛风石的存在与肌酐清除率之间的相关性最强。在逻辑回归分析中，即使在调整了种族、皮质类固醇使用、秋水仙碱使用和利尿剂使用后，肌酐清除率≤30ml/min 与痛风石的存在仍相关（多变量调整后的优势比为 7.0，p=0.005）。有痛风石的患者报告痛风发作频率更高、疼痛评分、患者整体评估评分和 HAQ 评分更高。
在病程<10 年的痛风患者中，痛风石的存在与更严重的症状性疾病相关。肌酐清除率与皮下痛风石的早期出现独立相关。
