Calabuig Irene, Martínez-Sanchis Agustín, Andrés Mariano
Sección de Reumatología, Hospital General Universitario de Alicante-Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
Front Med (Lausanne). 2021 Dec 16;8:795984. doi: 10.3389/fmed.2021.795984. eCollection 2021.
Gout and cardiovascular disease are closely related, but the mechanism connecting them remains unknown. This study aims to explore whether urate crystal deposits and inflammation (assessed by ultrasound) are associated with carotid atherosclerosis. We included consecutive patients with crystal-proven gout newly presenting to a tertiary rheumatology unit. Patients under urate-lowering treatment were excluded. Ultrasound assessment was performed during intercritical periods. Musculoskeletal scans evaluated six joints and four tendons for urate crystal deposits (double contour, aggregates, and tophi), and power Doppler (PD) signal (graded 0-3) as a marker of local inflammation. The sum of locations showing deposits or a positive PD signal (≥1) was registered. Carotids were scanned for increased intima-media thickness (IMT) and atheroma plaques, according to the Mannheim consensus. Associations were analyzed using logistic regression. The study included 103 patients showing sonographic crystal deposits at the examined locations (mean sum 9.9, minimum 2); tophi were the most frequent. Two-thirds of participants presented a positive PD signal (30.1% grade 2-3). In the carotid scans, 59.2% of participants showed atheroma plaques, and 33.0% increased IMT. Tophi (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03-1.50) and a positive PD signal (OR 1.67; 95% CI 1.09-2.56) were significantly associated with atheroma plaques, while an increased IMT showed no sonographic association. Sonographic crystal deposits and subclinical inflammation were consistently observed in patients with intercritical gout. Tophi and a positive PD signal were linked to carotid atherosclerosis. Our findings may contribute to understanding the complex relationship between gout and atherosclerosis.
痛风与心血管疾病密切相关，但其关联机制尚不清楚。本研究旨在探讨尿酸盐晶体沉积和炎症（通过超声评估）是否与颈动脉粥样硬化相关。我们纳入了连续就诊于三级风湿病科且经晶体证实为新发痛风的患者。正在接受降尿酸治疗的患者被排除。在发作间期进行超声评估。肌肉骨骼扫描评估六个关节和四条肌腱是否存在尿酸盐晶体沉积（双轮廓、聚集体和痛风石），以及功率多普勒（PD）信号（分级为0 - 3）作为局部炎症的标志物。记录显示有沉积或阳性PD信号（≥1）的部位总数。根据曼海姆共识，对颈动脉进行扫描以检测内膜中层厚度（IMT）增加和动脉粥样斑块。使用逻辑回归分析相关性。该研究纳入了103例在检查部位有超声晶体沉积的患者（平均总数为9.9，最小值为2）；痛风石最为常见。三分之二的参与者呈现阳性PD信号（30.1%为2 - 3级）。在颈动脉扫描中，59.2%的参与者显示有动脉粥样斑块，33.0%的参与者IMT增加。痛风石（比值比[OR] 1.24；95%置信区间[CI] 1.03 - 1.50）和阳性PD信号（OR 1.67；95% CI 1.09 - 2.56）与动脉粥样斑块显著相关，而IMT增加与超声检查无关联。在发作间期痛风患者中持续观察到超声晶体沉积和亚临床炎症。痛风石和阳性PD信号与颈动脉粥样硬化有关。我们的研究结果可能有助于理解痛风与动脉粥样硬化之间的复杂关系。
