Peiteado Diana, Villalba Alejandro, Martín-Mola Emilio, de Miguel Eugenio
Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain.
Clin Exp Rheumatol. 2015 May-Jun;33(3):385-90. Epub 2015 Apr 16.
We undertook this study to evaluate the responsiveness of Doppler ultrasound (US) to urate lowering therapy (ULT) in gout patients.
Twenty-four consecutive patients were prospectively included from an outpatient clinic. The patients underwent clinical, and US assessment at baseline and after 6, 12 and 24 months of ULT. The US assessment was made by another rheumatologist blinded to the clinical data. Standardised examinations were performed in four joints (both first metatarso-phalangeals and knees) and the patellar tendons. The Doppler signals were scored. The mean and standard deviation were calculated for each parameter. The comparison between the quantitative values was performed by Student's t-test. Sensitivity to change in the US examinations was assessed by estimating the smallest detectable difference (SDD) in the total Doppler score.
A Doppler signal was detected in 95.8% of the patients at the baseline. A significant parallel improvement in the serum urate level, clinical parameters and in Doppler scores was found at the follow-up assessment. 62% of the patients had achieved a uric concentration level below 6 mg/dl at one year. At two years, persistence of a Doppler signal was found in 72.7% of the patients. The SDD in the Doppler score at 2 years was 1.92, lower than the difference achieved.
The Doppler US findings show significant improvement and responsiveness after ULT in gout patients. The Doppler signal persistence after two years of treatment is marked. This finding introduces a reflection on the accuracy of the current outcome measures and treatments.
我们开展这项研究以评估多普勒超声（US）对痛风患者降尿酸治疗（ULT）的反应性。
前瞻性地纳入了来自门诊连续就诊的24例患者。患者在基线时以及ULT治疗6、12和24个月后接受临床和US评估。US评估由另一位对临床数据不知情的风湿病学家进行。在四个关节（双侧第一跖趾关节和膝关节）以及髌腱进行标准化检查。对多普勒信号进行评分。计算每个参数的均值和标准差。通过学生t检验对定量值进行比较。通过估计总多普勒评分中最小可检测差异（SDD）来评估US检查对变化的敏感性。
基线时95.8%的患者检测到多普勒信号。在随访评估中发现血清尿酸水平、临床参数和多普勒评分有显著的平行改善。62%的患者在一年时尿酸浓度水平低于6mg/dl。两年时，72.7%的患者发现多普勒信号持续存在。两年时多普勒评分的SDD为1.92，低于所达到的差异。
多普勒US检查结果显示痛风患者接受ULT治疗后有显著改善和反应性。治疗两年后多普勒信号持续存在很明显。这一发现引发了对当前结局指标和治疗准确性的思考。
