The Usage Of Musculoskeletal Ultrasound In Gouty Arthritis

OBJECTIVES:Patients with gouty arthritis(GA) were recruited from rheumatology clinicsin the People s Liberation Army general hospital in this study. The sonographicfeatures of involving joints of GA patients and the non-gouty arthritis patients(non-GA) were compared. The aim of this study is to identify the characteristicsonographic features of gout in musculoskeletal ultrasound (MSUS), to evaluatethe utility of MSUS in diagnosing gouty arthritis, and to explore whethermusculoskeletal ultrasound can be used in diagnosis of gouty arthritis.MEHTODS:Patients with arthritis were recruited from rheumatology clinics in the PLAgeneral hospital. The gouty arthritis patients were diagnosed by the ACR goutyarthritis classification criteria. Their involving joints were examined by themusculoskeletal ultrasound.The1st part:. The control group recruited non-goutyarthritis patients at the same way. Age and gender were matched in both groups.The2nd part: Total21gouty arthritis patients were enrolled. The control grouprecruited Rheumatoid Arthritis(RA) patients at the same way. Age and genderwere matched in both groups. What the involving joints must be measured in bothgroups by ultrasound weree synovitis, synovitis fluid, tenosynovitis, bursitis, softtissue, bone erosion and the degree of inflammation on synovium.RESULTS:The1st part: By polarize light examination of the tophus and effusion of thejoints,111gouty arthritis patients were enrolled. By comparing the GA group andthe control group, there are more tophus，“double contour sign”and hyperechoicfoci in GA group than control group(p<0.05). More bone erosion (p=0.021)andtenosynovitis (p=0.004). in non-GA than GA group. There is no significant difference between two groups in synovitis, ossification; the entheses boneerosion, soft tissue swelling and vascularity.If the ACR criteria is the goldencriteria, the sensitivity and the specificity of the ultrasound in diagnosing gout: thesensitivity of tophus, the double contour sign, hyperechoic foci and hyperechoicstrap in tendon were5.4%,54.9%,5.4%and4.3%. The specificity were100%,92.9%,98.9%and100%.Tophus, double contour sign, bright stippled focior bright stippled foci in tendons together were60.3%and92.4%。The area underthe ROC is0.764(p<0.05).The correlation between these two methods ismoderate(κ=0.527，p<0.05). The2nd part:21gouty arthritis patients and17RApatients were enrolled. By comparing the GA group and the control group, thereare26joint have “double contour sign(DC)” in GA group,but only4joints in RAgroup(p<0.05). there are14joint have tenosynovitis in RA group,but only14joints in GA group(p<0.05). There is no significant difference between two groupsin synovitis, synovitis fluid, bursitis, soft tissue swelling and vascularity.In GAgroup, lateral malleolus have more DC and thickness of synovitis fluid thanmedial malleolus(p<0.05),but medial malleolus have more thickness oftenosynovitis than lateral malleolus(p<0.05). There is no significant difference inRA(p>0.05).The area under the ROC of DC is0.78. The area under the ROC oftenosynovitis is0.74.CONCLUSIONS:(1) The1st part:Compared with non-GApatients, GApatients characteristicsonographic features were: an inhomogeneously echoic echotexture,hyperechoic spots in joints,”double contour sign”, hyperechoic straps in tendonand so on. GA patients have less tenosynovitis than non-GA patients. And the GApatients with shorter disease course have less bone erosion than non-GA patients.Comparing the ultrasound with the ACR classification criteria, one ofcharacteristic sonographic features has a high specificity and a low sensitivity. Buttophus, double contour sign, bright stippled foci or bright stippled foci in tendonstogether suggest a high specificity and a high sensitivity. The correlation between the ultrasound and the ACR criteria is moderate.(2)The2nd part: GA patients have the different characteristic image from the RAPatients.GA has more DC, but less tenosynovitis. And lateral malleolus have moreDC and thickness of synovitis fluid than medial malleolus in GA. Medialmalleolus has more thickness of tenosynovitis. In RA, there are moretenosynovitis, but less DC. There s no difference in two groups.