Carter John D, Patelli Michelle, Anderson Scott R, Prakash Neelesh, Rodriquez Ernesto J, Bateman Helen, Sterrett Ashley, Valeriano Joanne, Ricca Louis R
University of South Florida, 12901 Bruce B. Downs Blvd, MDC 81, Tampa, FL, 33612, USA,
Clin Rheumatol. 2015 Feb;34(2):345-51. doi: 10.1007/s10067-014-2644-9. Epub 2014 May 7.
It is unclear when the synovial-based inflammatory process of gout begins. The aim of this study was to determine the percentage of patients with inter-critical gout who have chronic synovial-based inflammation as evidenced by synovial pannus on a contrast-enhanced magnetic resonance imaging (MRI) of their most involved joint and determine if the presence and/or severity correlates with their serum urate levels. All patients received a 3 T MRI of their index joint, serum urate level, CRP, and creatinine. The primary endpoint was to determine the prevalence of synovial pannus and the correlation of serum urate levels with the presence and/or severity of the synovial pannus on that same joint. MRI erosions, tophi, swelling, effusion, and osteitis were also documented. Seventy-two of 74 subjects (90% men) completed the protocol. Fifty-three of 72 (74%) index joints were the first metatarsophalangeal joint. Thirty-nine (54.2%) of the patients were on urate-lowering therapy; 15 (20.8%) and 7 (9.7%) were taking colchicine or a NSAID daily, respectively. Of the 72 subjects, 63 (87.5%) had synovial pannus on their MRI with good inter-reader agreement between the two radiologists. The mean serum urate level was 7.93 mg/dL. There was no correlation with the presence (p = 0.33) or severity (p = 0.34) of synovial pannus and serum urate levels. There was also no correlation with the presence or severity of synovial pannus and the secondary endpoints. The majority of patients with inter-critical gout have evidence of chronic synovial-based inflammation. However, the presence and severity of this inflammation do not appear to correlate with serum urate levels.
痛风基于滑膜的炎症过程何时开始尚不清楚。本研究的目的是确定在对比增强磁共振成像（MRI）上，其最受累关节出现滑膜血管翳所证实的慢性滑膜炎症的间歇期痛风患者的比例，并确定其存在和/或严重程度是否与血清尿酸水平相关。所有患者均接受了其受累关节的3T MRI检查、血清尿酸水平、C反应蛋白（CRP）和肌酐检测。主要终点是确定滑膜血管翳的患病率以及血清尿酸水平与同一关节滑膜血管翳的存在和/或严重程度之间的相关性。还记录了MRI上的侵蚀、痛风石、肿胀、积液和骨炎情况。74名受试者中的72名（90%为男性）完成了该方案。72个受累关节中的53个（74%）是第一跖趾关节。39名（54.2%）患者正在接受降尿酸治疗；15名（20.8%）和7名（9.7%）患者分别每天服用秋水仙碱或非甾体抗炎药（NSAID）。在72名受试者中，63名（87.5%）在MRI上有滑膜血管翳，两位放射科医生之间的阅片者间一致性良好。血清尿酸平均水平为7.93mg/dL。滑膜血管翳的存在（p = 0.33）或严重程度（p = 0.34）与血清尿酸水平之间无相关性。滑膜血管翳的存在或严重程度与次要终点之间也无相关性。大多数间歇期痛风患者有慢性滑膜炎症的证据。然而，这种炎症的存在和严重程度似乎与血清尿酸水平无关。
