Rheumatology Department, Dr. Balmis General University Hospital-ISABIAL, Alicante, Spain.
Rheumatology Department, Hôpital Saint-Philibert, Lille Catholic Hospitals, Lille, France.
Int J Rheum Dis. 2023 Dec;26(12):2450-2459. doi: 10.1111/1756-185X.14935. Epub 2023 Oct 2.
To assess whether the extent of monosodium urate (MSU) crystal deposition estimated by ultrasound could predict renal and cardiometabolic events during urate-lowering therapy (ULT).
A prospective study on gout patients from two referral centers initiating ULT who underwent baseline ultrasound and were followed for 1 year. Ultrasound scans assessed six joints for double-contour (DC) signs and tophi. A five-point change (mL/min/1.73 m ) in the glomerular filtration rate at month 12 (M12) was considered significant. Outcomes of interest were renal function degraded versus improved and a composite cardiometabolic outcome (new hypertension, diabetes, atherosclerotic disease, and cardiovascular death). Homogeneity analyses and Cox regression models were performed.
One hundred sixty patients were recruited. At baseline, 81.1% of patients (n = 129) showed sonographic tophi with a mean number of 1.4 joints (±1.3) with a DC sign. At M12, 18 patients (11.3%) were lost to follow-up. The serum urate (SU) target (<6.0 mg/dL) was reached in 86 patients (69.9%). Regarding renal function, 15.9% of patients showed improvement, while in 31.0% it degraded. Fourteen new cardiometabolic events occurred in 12 patients. Neither the DC sign nor tophi showed any significant impact on the outcomes of interest. Baseline SU level was higher in those with renal improvement but not with renal decline, while achieving the SU target protected against new cardiometabolic events (HR = 0.2; 95% CI: 0.05-0.81).
Sonographic MSU crystal burden was unhelpful in predicting renal and cardiometabolic events during the first year of ULT. Reaching the SU target prevented cardiometabolic events, while its benefit in preserving/improving renal function is unclear.
评估超声估计的单钠尿酸盐（MSU）晶体沉积程度是否可以预测降尿酸治疗（ULT）期间的肾脏和心脏代谢事件。
这是一项来自两个转诊中心的痛风患者的前瞻性研究，这些患者开始 ULT 并接受基线超声检查，随后随访 1 年。超声扫描评估了 6 个关节的双轮廓（DC）征象和痛风石。第 12 个月（M12）肾小球滤过率（GFR）变化（mL/min/1.73m ）≥5 被认为是显著的。感兴趣的结果是肾功能恶化与改善以及心脏代谢复合结局（新发高血压、糖尿病、动脉粥样硬化疾病和心血管死亡）。进行了同质性分析和 Cox 回归模型。
共招募了 160 名患者。基线时，81.1%（n=129）的患者存在超声痛风石，平均有 1.4 个关节（±1.3）存在 DC 征象。在 M12 时，有 18 名患者（11.3%）失访。86 名患者（69.9%）达到了血清尿酸（SU）目标（<6.0mg/dL）。在肾功能方面，15.9%的患者肾功能改善，31.0%的患者肾功能恶化。12 名患者发生了 14 例新的心脏代谢事件。DC 征象或痛风石均与这些结果无关。肾功能改善的患者基线 SU 水平较高，但肾功能下降的患者基线 SU 水平无差异，而达到 SU 目标可预防新的心脏代谢事件（HR=0.2；95%CI：0.05-0.81）。
在 ULT 的第一年，超声 MSU 晶体负荷对预测肾脏和心脏代谢事件没有帮助。达到 SU 目标可预防心脏代谢事件，但其对保护/改善肾功能的益处尚不清楚。
