Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Rheumatology (Oxford). 2022 Nov 28;61(12):4711-4721. doi: 10.1093/rheumatology/keac179.
The objectives of this study were (i) to evaluate the responsiveness of gout-specific US lesions representing urate deposition in patients receiving treat-to-target urate-lowering therapy using a binary and the OMERACT-defined semi-quantitative scoring systems; (ii) to determine the most responsive US measure for urate deposition and the optimal joint/tendon set for monitoring this.
US (28 joints, 14 tendons) was performed in microscopically verified gout patients initiating/increasing urate-lowering therapy and repeated after 6 and 12 months. Static images/videos of pathologies were stored and scored binarily and semi-quantitatively for tophus, double contour sign (DC) and aggregates. Lesion scores were calculated at patient level, as were combined crystal sum scores. Responsiveness of lesions-scored binarily and semi-quantitatively-was calculated at both patient and joint/tendon levels.
Sixty-three patients underwent longitudinal evaluation. The static images/videos assessed retrospectively showed statistically significant decreases in tophus and DC, when scored binarily and semi-quantitatively, whereas aggregates were almost unchanged during follow-up. The responsiveness of the semi-quantitative tophus and DC sum scores were markedly higher than when using binary scoring. The most responsive measure for urate deposition was a combined semi-quantitative tophus-DC-sum score. A feasible joint/tendon set for monitoring included knee and first-second MTP joints and peroneus and distal patella tendons (all bilateral), representing the most prevalent and responsive sites.
The OMERACT consensus-based semi-quantitative US gout scoring system showed longitudinal validity with both tophus and DC being highly responsive to treatment when assessed in static images/videos. A responsive US measure for urate deposition and a feasible joint/tendon set for monitoring were proposed and may prove valuable in future longitudinal studies.
本研究的目的是(i)使用二进制和 OMERACT 定义的半定量评分系统，评估接受目标尿酸降低治疗的患者尿酸沉积的痛风特异性 US 病变的反应性；(ii)确定最敏感的尿酸沉积 US 测量方法以及监测此方法的最佳关节/肌腱集。
在开始/增加尿酸降低治疗的显微镜下证实的痛风患者中进行 US（28 个关节，14 个肌腱）检查，并在 6 和 12 个月后重复检查。对病理的静态图像/视频进行存储，并以二进制和半定量方式对痛风石、双重轮廓征（DC）和聚集物进行评分。在患者水平上计算病变评分，以及晶体总和评分。在患者和关节/肌腱水平上计算病变的二进制和半定量评分的反应性。
63 名患者接受了纵向评估。回顾性评估的静态图像/视频显示，痛风石和 DC 的二进制和半定量评分均有统计学意义的降低，而聚集物在随访期间几乎没有变化。半定量痛风石和 DC 总和评分的反应性明显高于二进制评分。尿酸沉积的最敏感测量是痛风石-DC 总和的半定量评分。用于监测的可行关节/肌腱集包括膝关节和第一至第二跖趾关节以及腓肠肌和远端髌腱（均为双侧），代表最常见和最敏感的部位。
基于 OMERACT 共识的半定量 US 痛风评分系统在静态图像/视频中显示出纵向有效性，痛风石和 DC 对治疗的反应性均很高。提出了一种敏感的尿酸沉积 US 测量方法和一种可行的关节/肌腱集用于监测，这可能在未来的纵向研究中具有重要价值。
