Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Ann Rheum Dis. 2015 Jun;74(6):1030-6. doi: 10.1136/annrheumdis-2013-204273. Epub 2014 Feb 12.
The aim of this work was to examine the relationship between joint damage and monosodium urate (MSU) crystal deposition in gout.
Plain radiographs and dual-energy CT (DECT) scans of the feet were prospectively obtained from 92 people with tophaceous gout. Subcutaneous tophus count was recorded. The ten metatarsophalangeal joints were scored on plain radiography for Sharp-van der Heijde erosion and joint space narrowing (JSN) scores, and presence of spur, osteophyte, periosteal new bone and sclerosis (920 total joints). DECT scans were analysed for the presence of MSU crystal deposition at the same joints.
DECT MSU crystal deposition was more frequently observed in joints with erosion (OR (95% CI) 8.5 (5.5 to 13.1)), JSN (4.2 (2.7 to 6.7%)), spur (7.9 (4.9 to 12.8)), osteophyte (3.9 (2.5 to 6.0)), periosteal new bone (7.0 (4.0 to 12.2)) and sclerosis (6.9 (4.6 to 10.2)), p<0.0001 for all. A strong linear relationship was observed in the frequency of joints affected by MSU crystals with radiographic erosion score (p<0.0001). The number of joints at each site with MSU crystal deposition correlated with all features of radiographic joint damage (r>0.88, p<0.05 for all). In linear regression models, the relationship between MSU crystal deposition and all radiographic changes except JSN and osteophytes persisted after adjusting for subcutaneous tophus count, serum urate concentration and disease duration.
MSU crystals are frequently present in joints affected by radiographic damage in gout. These findings support the concept that MSU crystals interact with articular tissues to influence the development of structural joint damage in this disease.
本研究旨在探讨痛风中关节损伤与单钠尿酸盐（MSU）晶体沉积之间的关系。
前瞻性收集 92 例痛风石患者的足部平片和双能 CT（DECT）扫描。记录皮下痛风石数量。在平片上对 10 个跖趾关节进行Sharp-van der Heijde 侵蚀和关节间隙狭窄（JSN）评分，并记录骨刺、骨赘、骨膜新骨和硬化（920 个关节）的存在情况。对 DECT 扫描进行分析，以确定同一关节是否存在 MSU 晶体沉积。
在存在侵蚀（OR（95%CI）8.5（5.5 至 13.1））、JSN（4.2（2.7 至 6.7%））、骨刺（7.9（4.9 至 12.8））、骨赘（3.9（2.5 至 6.0））、骨膜新骨（7.0（4.0 至 12.2））和硬化（6.9（4.6 至 10.2））的关节中，更频繁地观察到 DECT MSU 晶体沉积，p<0.0001。在 MSU 晶体沉积的关节频率与放射学侵蚀评分之间观察到强烈的线性关系（p<0.0001）。每个部位有 MSU 晶体沉积的关节数量与所有放射学关节损伤特征相关（r>0.88，p<0.05）。在线性回归模型中，在调整皮下痛风石数量、血清尿酸浓度和疾病持续时间后，MSU 晶体沉积与除 JSN 和骨赘以外的所有放射学变化之间的关系仍然存在。
MSU 晶体在痛风中受放射学损伤影响的关节中经常存在。这些发现支持这样一种观点，即 MSU 晶体与关节组织相互作用，影响该疾病结构关节损伤的发展。
