Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
Klinikum Nuremberg, Radiologie Nuremberg, Nuremberg, Germany.
Arthritis Rheumatol. 2020 Jan;72(1):150-156. doi: 10.1002/art.41063. Epub 2019 Dec 10.
Few studies have systematically and quantitatively addressed the impact of urate-lowering therapy on monosodium urate (MSU) deposits. This study was undertaken to analyze the effect of lifestyle measures and conventional urate-lowering therapy on MSU deposits in patients with gout.
In this prospective study, subjects with gout according to the American College of Rheumatology/European League Against Rheumatism classification criteria and presence of MSU deposits seen on dual-energy computed tomography (DECT) scans received either lifestyle intervention or conventional urate-lowering therapy for a mean period of 18 months before a follow-up DECT scan. Detected MSU deposits were quantified by volumetric measurement and validated by semiquantitative scoring, and baseline and follow-up measurements were compared.
Baseline and follow-up DECT scans were available for all 83 subjects. Six subjects discontinued treatment, and 77 subjects underwent a lifestyle intervention (n = 24) or were treated with allopurinol (n = 29), febuxostat (n = 22), or benzbromarone (n = 2) over the entire observation period. The mean serum uric acid (UA) level decreased from 7.2 to 5.8 mg/dl in the overall population. In patients who discontinued treatment, no change in MSU deposits or serum UA levels was observed. The burden of MSU deposits significantly decreased in patients undergoing lifestyle intervention (MSU volume P = 0.007; MSU score P = 0.001), and in patients treated with allopurinol (MSU volume and score P < 0.001) or febuxostat (MSU volume P < 0.001; MSU score P = 0.001). No significant decline in MSU deposits was noted in patients who discontinued treatment.
These data show that lifestyle intervention and xanthine oxidase inhibitors significantly decrease the MSU deposit burden. Hence, conventional gout therapy not only lowers serum UA levels, but also reduces pathologic MSU deposits.
鲜有研究系统且定量地评估降尿酸治疗对单钠尿酸盐（MSU）沉积的影响。本研究旨在分析生活方式干预和常规降尿酸治疗对痛风患者 MSU 沉积的影响。
在这项前瞻性研究中，根据美国风湿病学会/欧洲抗风湿病联盟分类标准诊断为痛风且双能 CT（DECT）扫描显示存在 MSU 沉积的患者接受生活方式干预或常规降尿酸治疗，平均治疗 18 个月后进行 DECT 随访扫描。通过容积测量法对检测到的 MSU 沉积进行定量，并通过半定量评分进行验证，比较基线和随访时的测量结果。
83 例患者均完成了基线和随访 DECT 扫描。6 例患者退出治疗，77 例患者接受生活方式干预（n = 24）或接受别嘌醇（n = 29）、非布司他（n = 22）或苯溴马隆（n = 2）治疗，整个观察期间接受了上述治疗。总体人群的血清尿酸（UA）水平从 7.2 降至 5.8 mg/dl。在停药的患者中，MSU 沉积或血清 UA 水平无变化。生活方式干预的患者 MSU 沉积负担显著减轻（MSU 容积 P = 0.007；MSU 评分 P = 0.001），别嘌醇（MSU 容积和评分 P < 0.001）或非布司他（MSU 容积 P < 0.001；MSU 评分 P = 0.001）治疗的患者 MSU 沉积也显著减轻。停药患者的 MSU 沉积无明显下降。
这些数据表明，生活方式干预和黄嘌呤氧化酶抑制剂可显著降低 MSU 沉积负担。因此，常规痛风治疗不仅降低血清 UA 水平，还减少病理性 MSU 沉积。
