| Objectives:1.To analyze the efficacy and value of ultrasound(US),dual energy CT(DECT)and minimally invasive arthroscopy in the diagnosis of knee gouty arthritis.2.To explore the dynamic changes of peripheral blood IL-22 and IL-37 in patients with gouty arthritis in the acute and remission phases,and their correlation with synovial lesions under joint ultrasound,hoping to further understand the pathogenesis of gout and to provide new targets for gout therapy.Methods:1.Patients with knee arthritis were collected from hospitalized patients during January 2016 to December 2018.All patients had swollen and pain of knee joint and had indications of minimally invasive arthroscopy.Clinical data were collected after their admission.Preoperative ultrasound(US)and dual energy CT(DECT)were used to evaluate the deposition of urate in the knee joint.After the evaluation,minimally invasive arthroscopy was performed.During the surgery,the distribution of urate deposition in the joint cavity was evaluated.The tissue samples were taken for pathological examination,and the joint fluid was taken for polarized light microscopy.Finally,patients were divided into two groups according to the examination results:gouty arthritis and non-gouty arthritis groups.2.From June 2018 to March 2019,36 patients with acute gout arthritis(AGA)were enrolled,and 14 healthy subjects were included as the control group.Clinical data and laboratory file of patients in both the acute and remission phase were collected.Peripheral blood of patients and control group was collected to measure for IL-22 and IL-37.In the same period,all the patients in gout group underwent ultrasound examination.The observation indicators were synovial thickening,synovial blood flow,and joint effusion,and their scores were calculated,and the correlation with IL-22 and IL-37 was analyzed.Results:1.Comparison of ultrasound,dual energy CT and minimally invasive arthroscopy:121 patients were included in the study,including 63 in the gout group and 58 in the non-gout group.Compared with the patients in non-gout group,the gout group was younger,had a higher proportion of males,and had higher levels of blood uric acid(UA)and C-reactive protein(CRP)(P<0.05).There was no statistical difference in the disease course,involved joints,the erythrocyte sedimentation rate(ESR)between two groups.In imaging study,there were significant differences between two groups in the double-track sign,strong echogenicity detected by ultrasonography,urate deposition detected by DECT and arthroscopy(P<0.05).(1)Diagnostic efficacy:in addition to the relatively low sensitivity of the double-tract sign(68.25%)and aggregates(42.86%)detected by ultrasound,the urate deposition evaluated by DECT and arthroscopy both have good diagnostic ability.Among the 63 patients in the gout group,59(93.6%)had urate deposition under arthroscopy,and 49(77.78%)had urate deposition on cartilage surface.(2)Diagnosis coincidence rate:44 patients found urate crystals in synovial pathology.Among them,the urate deposition confirmed by ultrasound,DECT and arthroscopy in 39 cases(88.64%),37 cases(84.09%),and 43 cases(97.73%),respectively.The highest rate of urate deposition was observed by arthroscopy(?2=39.898,p<0.001).(3)Consistency evaluation:the double-track sign showed good consistency with urate deposition on the cartilage surface detected by arthroscopy(Kappa coefficient 0.711,P<0.001).There was also good consistency between urate deposition in DECT and arthroscopy(Kappa coefficient 0.685,P<0.001).2.Cytokine levels and their correlation with synovial hyperplasia and blood flow:36 patients with gout arthritis and 14 healthy volunteers were included in the study.(1)The differences of IL-22 and IL-37 in the acute phase,remission phase and control group were all significant(P<0.05).(2)IL-22,IL-37 in acute phase patients and IL-37 in remission phase were significantly higher than those in control group(P<0.05).IL-22 in remission phase is lower than acute phase,IL-37 is higher than acute phase.(3)IL-37 in the acute phase was positively correlated with ESR,CRP and platelet elevation.(4)IL-22 was positively correlated with joint effusion scores in both acute and remission phase(P<0.05).conclusions1.In the diagnosis of knee gouty arthritis,minimally invasive arthroscopy,ultrasound and DECT all have good sensitivity and specificity.The sensitivity and specificity of minimally invasive arthroscopy are better than ultrasound and DECT.Minimally invasive arthroscopy is an important auxiliary method for the diagnosis of gout,especially when imaging cannot confirmed the diagnosis.2.The double-tract sign and the urate deposition on DECT both can predict the deposition of urate in the articular cavity,with a high specificity.There is no need for invasive examination in patients with these two signs.3.Both IL-22 and IL-37 are involved in the development of gout,both of which are elevated in the acute phase,IL-37 is higher in the remission phase and IL-22 is decreased.This result indicates that IL-22 may play a pro-inflammatory role and accelerate inflammation,and IL-37 may participate in the inflammatory response process of gout as an anti-inflammatory factor.IL-22 may become a potential target for the treatment of gout,and IL-37 may provide new research goals for the pathogenesis and treatment of gout.4.No correlation was found between IL-22 and IL-37 and synovial thickening and synovial blood flow under ultrasound.However,IL-22 may be involved in the development of joint effusion,and the relationship between IL-22 and synovial lesions needs to be further studied. |
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