Abstract
Objective To evaluate monosodium urate (MSU) crystal deposition and related lesions in the joints of patients with gout and hyperuricemia (HUA) using ultrasound. To explore the association between ultrasound findings and clinical features in gout and HUA. Methods A total of 202 patients with gout and 43 asymptomatic patients with HUA were included. The clinical data and ultrasonic assessment results were collected and statistically analyzed. Results Deposition of MSU crystals was found in 25.58% (11/43) of patients with asymptomatic HUA and 76.24% (154/202) of patients with gout. Of the 1,082 joints from patients with gout examined, 33.09% (358/1082) displayed MSU crystal deposition. In the joints with MSU crystal deposition, 77.37% (277/358) had a history of attacks. Among the joints of gouty arthritis, double contour sign (DCS), hyperechoic aggregate (HAG), and tophi were found in 32.65% (159/487), 7.80% (38/487), and 24.64% (120/487) of the joints, respectively. DCS and tophi, but not HAG, increasingly appeared with the extension of gout duration. In patients with more than 15 years of gout history, DCS, Tophi, and HAG were found in 48.18%, 40.00%, and 6.36% of US assessed joints, respectively. In patients with gout, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. The synovial lesion was related to HAG, while bone erosion was related to tophi and DCS. Nephrolithiasis was detected in 20.30% (41/202) of patients with gout and 4.65% (2/43) of HUA patients, indicating that nephrolithiasis occurred in more patients with gout than in patients with HUA. Conclusion HAG is an early performance of MSU crystal deposition in joints of gout and HUA. Both DCS and tophi are risk factors for bone erosion. Early urate-lowering therapy (ULT) should be considered in patients with gout, DCS, or tophi.
Highlights
Gout is a common inflammatory disease induced by the deposition of monosodium urate (MSU) crystals in joints and surrounding soft tissues, and hyperuricemia (HUA) is a critical factor for developing symptomatic gout
body mass index (BMI) in both gout (25:59 ± 3:48) and HUA (25:64 ± 3:03) patients was higher than the normal value (18.5–23.9), and there was no significant difference between the two groups of patients
Serum uric acid (SUA) in patients with gout (524:24 ± 79:68) was higher than in HUA patients (493:40 ± 66:85), which might be due to the longer course of HUA in the gout group
Summary
Gout is a common inflammatory disease induced by the deposition of monosodium urate (MSU) crystals in joints and surrounding soft tissues, and hyperuricemia (HUA) is a critical factor for developing symptomatic gout. Most HUA patients do not have gouty arthritis, MUS crystals are detected in their joints [1, 2]. Soreness, or numbness in the joints is reported in some patients without convincing clinical evidence of a gouty attack, and it is difficult to differentiate gout from osteoarthritis or other chronic arthritis. Noninvasive imaging evidence of urate deposition in joints is valuable and helpful for differential diagnosis [3]. Ultrasound (US), a noninvasive, free of ionizing radiation, convenient, and inexpensive approach, has recently been used to identify MSU crystal deposits for diagnosing gout [4, 5]. Synovial lesions (i.e., synovial hypertrophy and synovitis) and bone erosion are Journal of Immunology Research regularly detected by ultrasound in gout and HUA patients [2]
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