Department of Rheumatology, Université Catholique de Lille, Lille, France.
Department of Radiology, Université Catholique de Lille, Lille, France.
RMD Open. 2023 Nov;9(4). doi: 10.1136/rmdopen-2023-003725.
To examine factors influencing the kinetics of monosodium urate (MSU) crystal dissolution measured with dual-energy computed tomography (DECT) during follow-up of patients with gout.
Patients with a diagnosis of gout with baseline knees and feet DECT scans exhibiting MSU crystal volumes ≥0.1 cm and at least one follow-up DECT were included. Spearman's correlation coefficient was used to search for association between change from baseline MSU crystal volume at 6, 12, 18 and 24 months and serum urate (SU) level. Associations between percentage change from the baseline volume of MSU crystal deposits and explanatory variables were assessed using linear mixed models.
Sixty-two patients (age 67.3±12.8 years; 53 (85%) males) cumulating 104 follow-up DECT scans were included. Overall, SU target levels (<6.0 and <5.0 mg/dL) were achieved by 48 (77%) and 36 (58%) patients, respectively. There was a good correlation (=0.66; p<0.0001) observed between SU level and percentage change in MSU crystal volume. The median decrease from baseline MSU crystal volume was greater in patients reaching the <5.0 mg/dL SU target than in those reaching ≥5.0 SU <6.0 mg/dL: -85% (95% CI: -94% to -72%) versus -40% (-57% to -22%; p<0.05) at 12 months. In multivariable analysis, time (in days) with a multilevel coefficient of -0.06 (95% CI: -0.08 to -0.03, p<0.001), hypertension (coefficient: 41.87, 95% CI: 16.38 to 67.18, p<0.01) and SU level <5.0 mg/dL (coefficient: -39.46, 95% CI: -70.93 to -8.34, p=0.02) were the only variables significantly associated with MSU crystal volume change.
In patients with DECT-measured MSU crystal deposition, reaching the <5.0 mg/dL SU target provides more extensive and rapid crystal dissolution than reaching the <6.0 mg/dL SU target.
探讨在痛风患者的随访中，应用双能 CT（DECT）检测单钠尿酸盐（MSU）晶体溶解动力学的影响因素。
纳入基线膝关节和足部 DECT 扫描显示 MSU 晶体体积≥0.1cm3 且至少有一次随访 DECT 的痛风患者。采用斯皮尔曼相关系数分析 MSU 晶体体积在 6、12、18 和 24 个月时的基线变化与血清尿酸（SU）水平之间的相关性。采用线性混合模型评估 MSU 晶体沉积基线体积百分比变化与解释变量之间的相关性。
共纳入 62 例患者（年龄 67.3±12.8 岁；53 例[85%]为男性），共进行了 104 次随访 DECT 扫描。总体而言，分别有 48 例（77%）和 36 例（58%）患者达到 SU 目标水平（<6.0 和 <5.0mg/dL）。SU 水平与 MSU 晶体体积百分比变化之间存在良好的相关性（r=0.66；p<0.0001）。与达到 SU≥5.0mg/dL<6.0mg/dL 目标的患者相比，达到 SU<5.0mg/dL 目标的患者 MSU 晶体体积的基线下降中位数更大：12 个月时为-85%（95%CI：-94%至-72%），而-40%（-57%至-22%；p<0.05）。多变量分析显示，时间（天）的多水平系数为-0.06（95%CI：-0.08 至-0.03，p<0.001）、高血压（系数：41.87，95%CI：16.38 至 67.18，p<0.01）和 SU<5.0mg/dL（系数：-39.46，95%CI：-70.93 至-8.34，p=0.02）是与 MSU 晶体体积变化显著相关的唯一变量。
在 DECT 测量的 MSU 晶体沉积患者中，达到 SU<5.0mg/dL 目标比达到 SU<6.0mg/dL 目标能更广泛、更快速地溶解晶体。
