Department of Rheumatology and Immunology, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China.
J Ultrasound Med. 2024 Feb;43(2):281-291. doi: 10.1002/jum.16358. Epub 2023 Oct 18.
To develop an ultrasound semi-quantitative scoring system for the diagnosis and evaluation of gout and hyperuricemia.
This study included 348 male patients: 81 patients with asymptomatic hyperuricemia, 182 patients with gout, and 85 patients with other arthritis. Clinical data were collected, ultrasound was detected, gout activity score was calculated to assess disease activity, and statistical analysis was performed.
Monosodium urate crystal deposition and subclinical arthritis were detected in 17 patients with asymptomatic hyperuricemia, with lesions concentrated in the metatarsophalangeal joint, ankle and peroneus-longus and brevis at rate of 91.8%. Gout was significantly higher than non-gouty arthritis in crystal scores (sum scores of double contour, aggregates, and tophi), but not in inflammation scores (sum scores of synovial hypertrophy, power Doppler [PD] activity, and tenosynovitis) and bone erosion. The optimal cut-off score for the diagnosis of gout by the crystal score was 2. The sensitivity, specificity, and AUC were 95.4%, 97.1%, and .965, respectively. Gout flare had higher inflammation scores than intercritical gout, while bone erosion scores were lower than intercritical gout. The active gout patients had higher ultrasound scores of tophi, bone erosion, and PD activity than the remission group (P < .001). The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) for the identification with high disease activity gout by ultrasound semi-quantitative composite score were 76.2%, 84.2%, and .812, respectively.
Ultrasound helps early identification of patients at risk in asymptomatic hyperuricemia. Ultrasound semi-quantitative scoring allows for more objective and accurate assessment of gout lesions, correlates with disease activity, and helps in the diagnosis and assessment of gout.
建立超声半定量评分系统，用于诊断和评估痛风和高尿酸血症。
本研究纳入 348 例男性患者：81 例无症状高尿酸血症患者，182 例痛风患者，85 例其他关节炎患者。收集临床资料，进行超声检查，计算痛风活动评分以评估疾病活动度，并进行统计学分析。
17 例无症状高尿酸血症患者发现单钠尿酸盐晶体沉积和亚临床关节炎，病变主要集中在跖趾关节、踝关节和腓骨长短肌，发生率为 91.8%。痛风患者的晶体评分（双轮廓、聚集物和痛风石总分）明显高于非痛风性关节炎患者，但炎症评分（滑膜增生、功率多普勒[PD]活动和腱鞘炎总分）和骨侵蚀无差异。晶体评分诊断痛风的最佳截断值为 2 分。其灵敏度、特异度和 AUC 分别为 95.4%、97.1%和 0.965。痛风发作期的炎症评分高于间歇期，而骨侵蚀评分低于间歇期。活动期痛风患者的痛风石、骨侵蚀和 PD 活动的超声评分均高于缓解期（P < 0.001）。超声半定量综合评分识别高疾病活动度痛风的灵敏度、特异度和受试者工作特征曲线下面积（AUC）分别为 76.2%、84.2%和 0.812。
超声有助于早期识别无症状高尿酸血症患者的高危人群。超声半定量评分可更客观、准确地评估痛风病变，与疾病活动度相关，有助于痛风的诊断和评估。
