Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
Clin Rheumatol. 2020 Jun;39(6):1953-1960. doi: 10.1007/s10067-020-04947-2. Epub 2020 Feb 15.
Tophus is a characteristic manifestation of advanced gout, the clinical significance of which is often underestimated. This study aimed to compare the difference of clinical and ultrasound features between gout patients with and without ultrasound-detected tophus and identify risk factors associated with the presence of ultrasonographic tophus in gout patients.
A total of 85 gout patients were divided into tophaceous (n = 54) and non-tophaceous group (n = 31) according to the presence of ultrasound-detected tophus. All patients underwent ultrasound examination of the bilateral knee, ankle, and first metatarsophalangeal joint (MTP1). Clinical information and ultrasound findings were compared between the groups. A multivariate logistic regression analysis to determine possible risk factors is associated with the number of ultrasound-detected tophaceous joints.
Older age, longer gout duration, higher gout flare frequency, lower estimated glomerular filtration rate (eGFR), and higher prevalence of hypertension, hyperlipidemia, and ultrasound manifestations including double contour sign (DCS) and erosion were observed in tophaceous patients from the univariate analysis. Multivariable logistic regression analysis showed that eGFR and disease duration were independently associated with the number of tophaceous joints. Lower eGFR and longer course duration were associated with a higher risk of tophi (B = -0.020, 0.141; P = 0.009, 0.010, respectively).
The main factors that may influence the formation of tophi are disease duration and eGFR.Key Points• Lower eGFR and longer course duration are independent risk factors of tophi formation in gout patients.• The incidence of ultrasound manifestations including double contour sign (DCS) and erosion in patients with tophi were higher than those without tophi.
痛风石是一种晚期痛风的特征性表现，其临床意义常被低估。本研究旨在比较痛风患者中超声检测到痛风石与无痛风石患者的临床和超声特征的差异，并确定与痛风患者超声痛风石存在相关的危险因素。
根据超声检测到的痛风石的存在，将 85 例痛风患者分为痛风石组（n=54）和非痛风石组（n=31）。所有患者均接受双侧膝关节、踝关节和第一跖趾关节（MTP1）的超声检查。比较两组的临床资料和超声表现。采用多元逻辑回归分析确定与超声检测到的痛风石关节数量相关的可能危险因素。
单因素分析显示，痛风石组患者年龄较大、痛风病程较长、痛风发作频率较高、估算肾小球滤过率（eGFR）较低，高血压、高脂血症的患病率较高，且超声表现包括双轮廓征（DCS）和侵蚀更为常见。多变量逻辑回归分析显示，eGFR 和疾病持续时间与痛风石关节数量独立相关。eGFR 降低和病程延长与痛风石形成的风险增加相关（B=-0.020，0.141；P=0.009，0.010）。
影响痛风石形成的主要因素是疾病持续时间和 eGFR。
较低的 eGFR 和较长的病程是痛风患者形成痛风石的独立危险因素。
有痛风石的患者超声表现包括双轮廓征（DCS）和侵蚀的发生率高于无痛风石的患者。
