A Cross-Sectional Study On Risk Factors For Tophus Formation With Types Of TCM Syndrome And Constitution

Background:The incidence of gout is currently increasing,with recurrent attacks,and more and more gout patients are developing tophus,showing a younger trend.The formation of tophus is one of the late manifestations of gout,which can occur throughout the body,causing pain,damage to bone and tissue,joint deformity and functional impairment,and In severe cases,the ulceration is prolonged and is prone to co-infection,seriously reducing patients’ quality of life.There is a paucity of research on tophus and it is important to further investigate the clinical features and risk factors of tophus.Objective:To analyse the morbidity characteristics of gout patients as well as the TCM syndromes types and types of TCM constitution,and to discuss the risk factors associated with the formation of tophus,so as to provide some reference for better management of gout,prevention and treatment of tophus as well as identification and treatment.Methods:A cross-sectional survey study was conducted to select 146 patients who were diagnosed with gout from December 2021 to December 2022 at the Department of Rheumatology and Immunology,Zhujiang Hospital of Southern Medical University.The general conditions and clinical data of the patients were recorded by means of a questionnaire,and the general data of the gout patients were described and analysed,and the patients were divided into a tophus group(62 cases)and a non-tophus group(84 cases)according to the presence or absence of tophus.The basic data of the patients in the two groups were compared,and the independent factors for the formation of tophus were analysed,and the TCM classification of the two groups was carried out to compare the characteristics of the TCM syndrome types and types of TCM constitution,and the physical distribution of the two groups.Results:The results of this survey showed that a total of 146 patients with gout were collected,of which 62 were combined with tophus.The mean age among the gout patients was 45.86±16.61 years and 80.8%of the patients had combined underlying metabolic disorders,with a relatively high number of combined diabetes/hyperglycemia,hyperlipemia and hypertension.Of those surveyed.70.1%did not like to exercise and 52.7%of the patients had the habit of staying up late,Obesity was found in 88.33%of the patients and 47.9%of them had the habit of drinking alcohol.In Chinese medicine,the type of gout patients are types of blood stasis and heat>phlegm blockage>dampness-heat stagnation>liver and kidney yin deficiency.Among the TCM constitution types,29.4%are Phlegm-Dampness,36.9%are Dampness-Heat,6.8%are Yang-deficiency,0.6%are Qi-deficiency,6.1%are Gentle,4.7%are Blood-Stasis,8.9%are Yin-deficiency,3.4%are Qi-deficiency,and 2.7%are special construction.There were statistical differences between the two groups in terms of age,duration of gout,number of attacks,history of alcohol consumption,history of high purine diet,comorbidities(diabetes/hyperglycemia,hypertension,urinary stones),treatment compliance(regular uric acid-lowering therapy in remission),history of hormone therapy,albumin,glomerular filtration rate(eGFR),urea nitrogen and blood creatinine(P<0.05),and no statistically significant differences in terms of gender,BMI,history of smoking,Family history,blood uric acid concentration,triglyceride and cholesterol were not statistically significant(P>0.05).Multiple logistic regression analysis showed that the duration of gout disease,hypertension,and history of hormone therapy were independently associated with tophus formation(P<0.05).In terms of the distribution of TCM syndrome,the tophus group was dominated by stagnation of blood stasis and heat type and phlegm blockage type,while the non-tophus group was dominated by dampness-heat stagnation syndrome type and stagnation of blood stasis and heat type.The distribution of the dampness-heat stagnation syndrome type was statistically different between the two groups(P<0.05).Conclusion:1.People with gout who have tophus may be more likely to have a combination of hypertension,diabetes/hyperglycemia,kidney damage,urinary stones,etc.2.Alcohol consumption,high purine diet,diabetes/hyperglycemia,urinary stones,irregular uric acid-lowering therapy may increase the risk of tophus formation.3.Hypertension,the course of gout and the use of hormone therapy are risk factors for the development of tophus.Patients with gout should actively control their blood pressure and reduce the use of hormone drugs.4.The common TCM constitution types for gout are Dampness-Heat,Phlegm-Dampness and Yin-Deficiency;stagnation of blood stasis and heat type and Phlegm blockage type are the main types of gout stones in patients with tophus,while patients with Dampness-heat stagnation syndrome inclusion evidence are less likely to develop gout tophus.5.Gout patients with liver and kidney yin deficiency evidence had a longer duration of illness than the other three groups,and the glomerular filtration rate level was significantly lower than the other three groups(P<0.05),so the duration of illness and glomerular filtration rate values can be used as auxiliary evaluation indicators when identifying the syndrome.