Comparative Study Of Musculoskeletal Ultrasound In Asymptomatic Hyperuricemia And Acute Gouty Arthritis

Objective:1)To explore the similarities and differences between the main ultrasound signs and the site of onset of asymptomatic hyperuricemia and acute gouty arthrit is by musculoskeletal ultrasonography;2)To explore the correlat ion between ultrasonography results and blood biochemical indexes,and to provide object ive basis for evaluating inflammatory activit y in patients with asymptomat ic hyperuricemia and acute gouty arthritis by ultrasonography;3)To explore the best threshold value of different ultrasound signs caused by urate deposit ion in the time of elevat ion of serum uric acid and the course of gou t.Materials and Methods:From July 2017 to December 2018,50 patients with acute gouty arthrit is and 50 patients with asymptomatic hyperuricemia were definitely diagnosed.All patients underwent ultrasound,blood biochemical examinat ion,height and weight measurement respectively.Ultrasound examinat ions were bilateral,including metatarsophalangeal(MTP),tarsometatarsal jo int,ankle joint,knee joint,shoulder joint,elbow joint and wrist joint.The contents of ultrasonographic observat ion were as follow s: double contour sign,crystalline deposit ion,tophus,joint effusion,synovial hyperplasia,bone erosion,attachment lesion,blood flow..Detection of serum uric acid,erythrocyte sedimentation rate and C-react ive protein by blood biochemical examination.Height and weight measurements were recorded in integer digits Results:1.Comparison of Ultrasound Characterist ics and Involved Joint Location: There were significant differences in ultrasound signs between the two groups except for attachment lesions(p < 0.01);The main affected jo ints in both groups were ankle and foot joints,and the main affected joints were the first metatarsophalangeal jo int(MTP1).The main symptoms in acute GA group were MTP1 synovial hyperplasia(86%)and MTP1 double contour sign(50%).The main symptoms in asymptomatic HUA group were MTP1 synovial hyperplasia(28%)and MTP1 effusion(26%).2.Correlat ion analysis between ultrasound characteristics and blood biochemical indexes: Synovial thickness and blood flow integral were positively correlated with ESR and CRP in both groups.There was no significant difference in the correlat ion between ultrasound features and UA indexes between the two groups.3.Analysis of correlation between ultrasonographic features and time of elevat ion of serum uric acid and course of gout :Except for the ultrasonographic features of acute gouty arthrit is group,the number of joints with attachment lesions was positively correlated with the time of elevated serum uric acid and the course of gout,respectively.In the asymptomat ic hyperuricemia group,the volume of jo int effusion and synovial membrane thickness were significantly correlated with the time of blood uric acid increase(r = 0.606,p < 0.001;r = 0.683,p < 0.001).In acute gouty arthrit is group,there was a significant correlat ion between the number of crystalline deposited jo ints and the time of elevated serum uric acid and the course of gout(r = 0.540,p < 0.001;r = 0.577,p < 0.001)4.ROC Analysis of Ultrasound Signs,Time of Blood Uric Acid Incre ase and Course of Gout: The cut-off values of serum uric acid elevation time in asymptomat ic hyperuricemia group were 22.5 and 25.5 months for evaluating ultrasound posit ive signs and double contour signs/crystallizat ion deposit ion,respectively.The time of elevated serum uric acid in acute gouty arthrit is group was used to evaluate the truncation values of double contour sign,double contour sign/crystalline deposit and tophus found by ultrasonography were 30.5,30.5 and 33 months,respectively.The truncated values of dual contour sign,dual contouur sign/crystalline deposit and tophus were 15.5,13 and 20.5(month)respectively,which were used to evaluate the course of gout in acute gouty arthritis group.Conclusions:1.Musculoskeletal ultrasonography can be used for screening high-risk groups of asymptomat ic hyperuricemia patients.Positive signs of jo int can be found in some patients,which is superior to blood biochemical examinat ion..2.The main sonographic signs of asymptomatic hyperuricemia and acute gouty arthritis were synovial hyperplasia,and the first metatarsophalangeal joint was the main site of the disease.3.The blood flow integral and synovial thickness of diseased joints can be used as indicators of inflammatory activity in patients with asymptomatic hyperuricemia and acute gouty arthrit is.4.The signs of uric acid deposition changed with the increase of serum uric acid and the course of gout.The signs of ultrasonography were crystalline deposit ion,double track sign and gout stone in turn.