Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China.
Department of Medicine, Qingdao University, Qingdao, PR China.
Semin Arthritis Rheum. 2024 Aug;67:152418. doi: 10.1016/j.semarthrit.2024.152418. Epub 2024 Feb 18.
To evaluate whether ultrasound findings of monosodium urate (MSU) crystal deposition predict frequent gout flares in index joints over 12 months.
This single-center study enrolled people with at least one gout flare involving the MTP1, ankle or knee joint. The most painful or most frequently joint was identified as index joint for analysis. All participants were started on urate-lowering therapy and had an ultrasound scan of the index joints at the baseline visit. OMERACT scores (for tophus, double contour sign and aggregates) were used to analyze whether ultrasound scores predicted frequent (≥2) gout flares in the index joint over 12 months.
Frequent flares were significantly higher in those with ultrasound findings in all index joints (MTP1: tophus: 85.0% vs 46.0%, P < 0.001, aggregates: 78.8% vs 59.0%, P < 0.01; ankle: tophus: 54.6% vs 20.8%, P < 0.001; aggregates: 60.0% vs 35.9%, P < 0.05; knee: tophus: 68.4% vs 28.6%, P < 0.05). For the MTP1, for each 1-point increase in tophus score, the odds of frequent gout flares increased by 5.19 [(95%CI: 1.26-21.41), 7.91 [(95%CI: 2.23-28.14), and 13.79 [(95%CI: 3.79-50.20)] fold respectively. For the ankle, a tophus score of 3 markedly improved the prediction of the frequent flares [OR= 9.24 (95%CI=2.85-29.91)]. Semi-quantitative sum scores were associated with frequent flares with an OR (95%CI) of 13.66 (3.44-54.18), P < 0.001 at the MTP1, 7.05 (1.98-25.12), P < 0.001 at the ankle.
Ultrasound features of MSU crystal deposition at the MTP1 and knee predict subsequent risk of frequent gout flares in the same joints following initiation of urate-lowering therapy, with the highest risk in those with high tophus scores.
评估单钠尿酸盐（MSU）晶体沉积的超声表现是否可预测 12 个月内索引关节频繁痛风发作。
本单中心研究纳入了至少有一次累及第一跖趾关节（MTP1）、踝关节或膝关节的痛风发作的患者。最痛或最常受累的关节被确定为分析的索引关节。所有参与者均开始降尿酸治疗，并在基线就诊时进行索引关节的超声检查。使用 OMERACT 评分（用于评估痛风石、双轨征和聚集物）来分析超声评分是否可预测 12 个月内索引关节频繁（≥2 次）痛风发作。
在所有索引关节（MTP1：痛风石：85.0%比 46.0%，P<0.001，聚集物：78.8%比 59.0%，P<0.01；踝关节：痛风石：54.6%比 20.8%，P<0.001；聚集物：60.0%比 35.9%，P<0.05；膝关节：痛风石：68.4%比 28.6%，P<0.05）中，频繁发作的发生率显著更高。对于 MTP1，痛风石评分每增加 1 分，痛风频繁发作的几率增加 5.19 倍[95%CI：1.26-21.41]、7.91 倍[95%CI：2.23-28.14]和 13.79 倍[95%CI：3.79-50.20]。对于踝关节，痛风石评分 3 分可显著提高频繁发作的预测能力[OR=9.24（95%CI=2.85-29.91）]。半定量总分与频繁发作相关，OR（95%CI）为 13.66（3.44-54.18），P<0.001 于 MTP1，7.05（1.98-25.12），P<0.001 于踝关节。
第一跖趾关节和膝关节的 MSU 晶体沉积的超声表现可预测降尿酸治疗后同一关节频繁痛风发作的风险，痛风石高评分者风险最高。
