| Objective:The goal of this study was to determine the related clinical features of tophi formation in gout patients from northeastern area of Sichuan in China.And then evaluated the curative effect of gouty tophus patients,eventually to explore the clinical strategies for treatment-to-target.Methods:1.1135 patients with gout and a cohort of 1002 control subjects without gout were included in the present study.All the patients from Affiliated Hospital of North Sichuan Medical College outpatient and inpatient department during January 2010 to March 2017.Clinical features and related clinical laboratory values were investigated in patients with tophi(tophi gout,TG)and without tophi(non-tophi gout,NTG).2.75 gouty tophus patients who were followed up for at least 24 weeks.Three groups were stratified according to their strategy in urate-lowering therapy.Patients only took xanthine oxidase inhibitor(A group),patients only took benzbromarone(B group),and the other patients were treated by two kinds of combination drugs(C group).Then efficacy and safety of the three groups were observed after12 and 24 weeks of treatment.The evaluation indexes include the level of blood uric acid,the frequency of gout attacks,the number of involved joints,the size of tophi,and adverse events were recorded,such as rash,liver damage,etc.3.Statistical analysis:SPSS 17.0 was used for the statistical analysis.The enumeration data were expressed as percentages and were compared with theχ~2 test.Measurement data were reported as mean±SD or Me(25th-75th%),and assessed using Student’s t-test and Wilcoxon rank sum test.Logistic regression analysis was separately used to analyze related risk factors of primary gout and the promotion of tophi.Paired t test was used to compare pre-and post-treatment.Chi-square test and one-way ANOVA was performed,when appropriate.Results:1.Characteristics of gout patients and related risk factors:among all the incident gout cases,only one joint was involved in the first attack in 97.36%of cases,while attacks involved the first metatarsophalangeal joint in 54.45%(618/1135).751 patients had predisposing factors,79.09%of which were related to dietary factors such as beer and seafood.Body mass index(BMI),serum uric acid(sUA),urea nitrogen,creatinine,glucose,White blood cells(WBC),neutrophils(GR),monocytes(Mo),globulin,total cholesterol,very low density lipoprotein(VLDL)cholesterol and apolipoprotein B100(apoB100)were significantly higher in the GA group than HC group(P﹤0.05,respectively).In contrast,lymph cells counts(LY),high-density lipoprotein(HDL)cholesterol and apolipoprotein A1(apoA1)were significantly lower in the GA group(P﹤0.05,respectively).In addition,multiple logistic regression analysis revealed that the occurrence of primary gout was correlated with the following factors:sUA,alcohol use,BMI,purine-rich diets,hypertriglyceridemia,hypertension and smoking(OR 8.016、5.643、4.312、2.861、4.208、2.750 and 2.223,respectively).2.Characteristics of gout tophus patients and related risk factors:187(16.48%)patients appeared clinical tophi,the average course of tophi formation was(4.78±1.91)years,and the average diameter of tophi was(17.94±10.93)mm.Tophi was mainly distributed in the subcutaneous parts of the toe,knee,ankle,finger,wrist,olecranon of elbow joint and auricle,the site of gouty tophus was consistent with the site of initial on set of gout in 87cases(46.52%),27(14.44%)patients with tophi located in joints but absent any inflammatory response.In TG group,the duration of disease was considerably longer and the sUA,creatinine,urea nitrogen as well as the prevalence of hypertension,positive family history of gout,the incidence of renal calculus and delay work rates were significantly higher than those in NTG group,whereas LY,albumin concentration,BMI and the proportions of urate-lowering therapy(ULT)were dramatically lower compare with the NTG group(P﹤0.05,respectively).And the incidence of tophi was positively correlated with course of diseases and serum levels of uric acid(OR=1.152,1.004;P﹤0.01),and negatively correlated with BMI(OR=0.911;P﹤0.05).3.Therapeutic effect and safety observation of gouty tophus patients:in the 75 gouty tophus patients who were treated at least 24 weeks,25 patients took xanthine oxidase inhibitor(A group),18 patients took benzbromarone(B group),and the other 32 patients took combination drugs(C group).After 12weeks treatment,the sUA level of patients was significantly decreased compared with untreated(t=12.143,P﹤0.001),the sUA level of A,B and C group was also decreased,but the difference was not statistically significant(P﹥0.05);After 24 weeks,the sUA were significantly decreased(P﹤0.05),and the C group was significantly lower than that of A and B group(P﹤0.05).During the 12 and 24 weeks,the frequency of gout attacks and the number of affected joints were significantly reduced(P﹤0.05).During the study,the number of affected joints in C group was less than that in B group(P﹤0.05),but the same differ could not found between C and A group(P﹥0.05).Exacerbation frequency were no differences in the A,B and C groups.After24 weeks of urate-lowering therapy,the tophi of 25(33.33%)patients become soft,and there was no obvious change in the volume of tophi.In addtion,there was no significant difference in the incidence of adverse effects among the three groups during the period of treatment(P>0.05).Conclusion:The first attack of gout usually affects only one lower-limb joint,and for polyarthritis especially in the upper-limb joints need to be more alert for misdiagnosed and missed diagnosis.When acute gout attack,in patients had predisposing factors,nearly 80%of which were related to high purine diet.However,there was some patients without any causes for acute attacks of gout.Hyperuricemia,alcohol intake,obesity,hypertriglyceridemia,purine-rich diets,hypertension and smoking were the most important risk factors for primary gout.Tophi was a common complication in gout patients.The patients with gouty tophus may be more easily associated with kidney damage,kidney stones and hypertension.Meanwhile,tophi may be more likely to occur in positive family history patients.Disease duration and concentration of sUA were risk factors of gout,and BMI may be the protective factor.Then,through long-term adherence to ULT,the tophi can gradually dissolved.The strategy combined inhibition and excretion of urate-lowering drugs was conducive to benefit than single inhibition or excretion agent.The study showed that there were no serious adverse events during oral febuxostat,allopurinol and benzbromarone,therefore,the three kinds of drugs were relatively safe when treat with gout. |
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