Clinical Application Of High-frequency Ultrasound In Gouty Arthritis

[Objective] This paper is to explore the value of high-frequency ultrasound in diagnosing first metatarsophalangeal joints(MTPJ) and other painful joints of patients with gouty arthritis and asymptomatic hyperuricemia.[Methods] Subjects were categorized into3diagnostic groups:the gouty arthritis group, asymptomatic hyperuricemia group and the control group. The gouty arthritis group had60patients, according to the American Rheumatism Association (ACR) diagnostic criteria of the GA, and excluding other arthritis. The asymptomatic hyperuricemia group had55patients who haven't gout history and serum uric acid level was above416umol/L. The Control group had52cases who haven't gout history and serum uric acid less than416umol/L. First MTP joints and other painful joints were examined in long and short axes from dorsal, plantar, and medial aspects respectively, observing whether the joints had effusion and synovial thickening, whether joints and around soft tissue had monosodium urate crystal deposition, whether bone and joint surface were smooth, the destruction of bone or not. Applying Color Doppler Flow Imaging (fine flow) to observe synovial membrane inner (or) surface blood flow, record detailed text and images of each inspected joint.[Results] The sensitivity and specificity of HRUS in diagnosing GA were69.2%,87.5%respectively. HRUS can detect the MSU crystal deposition in lesions joint and around soft tissue, typical bone destruction performance in GA. The ultrasonographic performance of MSU crystal deposition including "double contour", hyperechoic sports and heterogeneous echo nodules. Applying HRUS, the positive relevance ratio of "double contour" in GA, AH and Control were45.8%,7.3%.0%, and hyperechoic sports were28.3%,30.9%,12.5%, and heterogeneous echo nodules were30.0%,2.7%,0%. The serum uric acid levels between patients with and without "double contour" are different (t=-1.997, p=0.047); The serum uric acid levels between patients with and without heterogeneous echo nodules are different (t'=-3.326, p=0.001); The serum uric acid levels between patients with and without hyperechoic sports were not statistically significance (t'=1.090, p=0.278). The relevance ratio of bone destruction in patients with heterogeneous echo nodules was28.2%. whereas2.0%in the patients without heterogeneous echo nodules, and the difference was statistically significance.[Conclusions]1. HRUS can detect the MSU crystal deposition of lesions joint and around soft tissue, typical bone destruction of performance in GA, and can be used as a noninvasive method for diagnosing GA, and can guide joint cavity (synovial sac) effusion drainage, tophus biopsy and drug-inject treatment.2. HRUS can detect the change of the joint disease in AH patients, offering basis for early clinical intervention treatment and prevent disease processing.3. HRUS can be able to follow the process of disease in patients with gout and AH. dynamic monitoring and evaluating drug therapy effect.