Fei Y N, Tang S M, Zhang G, Li Y H, Shao M, Xie L F, Zhong Y C, Zhang X W
Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Yi Xue Za Zhi. 2018 Apr 3;98(13):978-981. doi: 10.3760/cma.j.issn.0376-2491.2018.13.005.
To observe the correlation between the different ultrasonic manifestations of gouty arthritis and the indexes of bone destruction (Dickkopf-1, RANKL), in order to further explore the role of musculoskeletal ultrasonography in the diagnosis and monitoring of gouty arthritis. 160 cases of gouty arthritis from clinic of the Department of Rheumatology of Peking University People's Hospital between July 2016 and June 2017 were recruited in this study. These patients were examined by musculoskeletal ultrasonography (bilateral first metatarsophalangeal joints, bilateral ankle joints and bilateral knee joints). Grouping was based on ultrasound features of joints. Group A showed no aggregate .Group B showed aggregate and double contour signs. Group C showed tophus and bone erosion. Serum concentrations of Dickkopf-1 and RANKL were measured. The correlations of Dickkopf-1 or RANKL and clinical/laboratory parameters were analyzed. (1)There was a significant difference in Dickkopf-1 concentration between the three groups(<0.001). And the group C[(1 722.2±482.7)ng/L]was higher than the group B[(1 309.3±496.4)ng/L](=4.418, <0.001), and the group B was higher than group A[(807.9±373.8)ng/L](=6.137, <0.001). (2)There was a significant difference in RANKL concentration between the three groups (<0.001). And the group C[(0.78±0.47)ng/L]was higher than the group B[(0.35±0.29)ng/L](=5.456, <0.001), and the group B was higher than group A[(0.10±0.09)ng/L](=6.923, <0.001). (3)The level of Dickkopf-1 was associated with the disease duration(=0.430, <0.001), and the level of RANKL was associated with the disease duration(=0.359, <0.001). Aggregates, double contour signs, tophus and bone erosion can be observed in the ultrasonic examination of gouty arthritis. And the longer the duration of the disease, the more likely the extent of bone destruction is. Joint ultrasound can be the first imaging examination for the extent of joint involvement in gouty arthritis. And the longer the duration of the disease, the more likely the extent of bone destruction is. Musculoskeletal ultrasonography can be the preferred imaging method for detecting the extent of joint involvement in gouty arthritis.
观察痛风性关节炎不同超声表现与骨破坏指标（Dickkopf-1、RANKL）之间的相关性，以进一步探讨肌肉骨骼超声在痛风性关节炎诊断及病情监测中的作用。选取2016年7月至2017年6月北京大学人民医院风湿免疫科门诊的160例痛风性关节炎患者纳入本研究。对这些患者进行肌肉骨骼超声检查（双侧第一跖趾关节、双侧踝关节及双侧膝关节）。根据关节超声特征进行分组。A组无聚集表现。B组有聚集及双轮廓征。C组有痛风石及骨质侵蚀。检测血清Dickkopf-1和RANKL浓度。分析Dickkopf-1或RANKL与临床/实验室参数的相关性。（1）三组间Dickkopf-1浓度差异有统计学意义（<0.001）。C组[（1722.2±482.7）ng/L]高于B组[（1309.3±496.4）ng/L]（=4.418，<0.001），B组高于A组[（807.9±373.8）ng/L]（=6.137，<0.001）。（2）三组间RANKL浓度差异有统计学意义（<0.001）。C组[（0.78±0.47）ng/L]高于B组[（0.35±0.29）ng/L]（=5.456，<0.001），B组高于A组[（0.10±0.09）ng/L]（=6.923，<0.001）。（3）Dickkopf-1水平与病程相关（=0.430，<0.001），RANKL水平与病程相关（=0.359，<0.001）。痛风性关节炎超声检查可观察到聚集、双轮廓征、痛风石及骨质侵蚀。且病程越长，骨质破坏程度越重。关节超声可作为痛风性关节炎关节受累程度的首选影像学检查。且病程越长，骨质破坏程度越重。肌肉骨骼超声可作为检测痛风性关节炎关节受累程度的首选影像学方法。
