Liu W, Guo W, Guo Z, Li C, Li Y, Liu S, Zhang L, Song H
Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
Department of Ultrasound, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Aug 18;57(4):735-739. doi: 10.19723/j.issn.1671-167X.2025.04.017.
To analyze the factors associated with non-radiographic bone erosion in gout patients, to improve the understanding of bone erosion in gout, and to promote the early detection of bone erosion.
A retrospective analysis was conducted on the medical records of gout patients treated at Beijing Jishuitan Hospital from January 2018 to January 2022. Bone erosion was detectable by ultrasound but not detected by X-ray as non-radiographic bone erosion; no bone erosion was detected by both ultrasound and joint X-ray as undetected bone erosion. A case-control study was used, and the two groups were matched 1 ∶ 2 according to age and sex. The differences between the two groups were compared in terms of general information, joint involvement characteristics, laboratory indicators and complications. In the univariate analysis, < 0.1 was included in the multivariate analysis, and the conditional Logistic regression was used for the multivariate analysis. < 0.05 was considered to have statistically significant differences.
Among the 41 patients with non-radiographic bone erosion, the top three joints with bone erosion before its occurrence were metatarsophalangeal joint (12 cases), ankle (10 cases), and knee (7 cases). There were 82 patients undetected with bone erosion. There were no significant differences in general information between the two groups (>0.05), including age, gender, body mass index, and alcohol consumption history. The characteristics of affected joints in the non-radio-graphic bone erosion group were compared with those in the no bone erosion detected, and the former had more affected joints (=0.02), and a higher proportion of patients with at least 3 attacks of gout per year ( < 0.001). There were no significant differences in serum uric acid, fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, creatinine, homocysteine, white blood cell count, and urine pH between the two groups (>0.05). The results of multivariate analysis showed that at least 3 flares of gout per year was an independent risk factor for radiologically negative bone erosion in patients with gout, with an (95%) of 5.139 (1.529-17.271).
At least 3 flares of gout per year predicts the occurrence of radiologically negative bone erosion, and these patients should be given more attention to achieving treatment targets.
分析痛风患者非放射性骨侵蚀的相关因素，提高对痛风性骨侵蚀的认识，促进骨侵蚀的早期发现。
对2018年1月至2022年1月在北京积水潭医院接受治疗的痛风患者病历进行回顾性分析。骨侵蚀可通过超声检测到但X线未检测到为非放射性骨侵蚀；超声和关节X线均未检测到骨侵蚀为未检测到骨侵蚀。采用病例对照研究，两组按年龄和性别1∶2匹配。比较两组在一般信息、关节受累特征、实验室指标和并发症方面的差异。单因素分析中，P<0.1纳入多因素分析，采用条件Logistic回归进行多因素分析。P<0.05认为差异有统计学意义。
41例非放射性骨侵蚀患者中，骨侵蚀发生前骨侵蚀累及关节前三位为跖趾关节（12例）、踝关节（10例）和膝关节（7例）。82例患者未检测到骨侵蚀。两组一般信息（P>0.05）无显著差异，包括年龄、性别、体重指数和饮酒史。将非放射性骨侵蚀组与未检测到骨侵蚀组的受累关节特征进行比较，前者受累关节更多（P=0.02），每年至少发作3次痛风的患者比例更高（P<0.001）。两组血清尿酸、空腹血糖、胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、肌酐、同型半胱氨酸、白细胞计数和尿pH值无显著差异（P>0.05）。多因素分析结果显示，每年至少发作3次痛风是痛风患者放射性阴性骨侵蚀的独立危险因素，比值比（95%可信区间）为5.139（1.529~17.271）。
每年至少发作3次痛风预示着放射性阴性骨侵蚀的发生，应对这些患者给予更多关注以实现治疗目标。
