| Objective:This study aimed to quantify the specific range of motion of the lower extremity joints in gout patients during non-acute phase,clarify the risk factors leading to joint mobility limitation and the affecting factors of joint mobility changes after regular treatment,and to provide a basis for the scientific management of gout patients.Methods:A total of 214 male gout patients who first visited the gout clinic of the Affiliated Hospital of Qingdao University,Qingdao,China from February 2021 to March 2022 were consecutively enrolled for a 6-month prospective observational study.At baseline,each patient underwent routine serologic tests,joint mobility measurement and imaging(ultrasound and dual-source CT)examinations of the lower extremity joints [first metatarsophalangeal joint(MTP1),ankle and knee] with most frequent and severe gout attacks,and all patients received standard uric acid-lowering therapy and other necessary treatments for comorbidities.The results of the above indicators and the information of the consultation were recorded in detail at baseline and each follow-up visit.The paired T-test,Wilcoxon signed rank test,or Mc Nemar test were appropriately used to investigate whether there were significant differences in ultrasound results and clinical indicators between baseline and 6 months after treatment,the range of joint mobility between the affected and healthy side of the lower limb joint at baseline,and between the affected side at baseline and 6 months after treatment in patients with gout.We constructed univariate and multivariate stepwise logistic regression analyses to explore the risk factors that might contribute to joint mobility limitation of the lower limbs and the potential influencing factors improving joint mobility.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive power of risk factors.Results:1.The cross-sectional analyses:(1)The mobility of the affected MTP1 was significantly less than that of the healthy side in all three directions of dorsiflexion,plantarflexion,and abduction(55.55±12.45 vs.61.57±10.89;38.77±7.27 vs.42.27±6.70;17.12±3.81 vs.19.33±2.69,P< 0.001);The range of motion of the affected knee in flexion direction was significantly less than that of the healthy side(124.00±8.30 vs.127.33±6.54,P= 0.020);However,there was no significant difference in the mobility in all directions of dorsiflexion,plantarflexion,valgus and inversion between the affected side of ankle joint and the healthy side(17.72 ±3.63 vs.18.29 ± 4.09;47.57 ± 5.51 vs.47.83 ± 5.38;26.07 ± 3.64 vs.26.79 ± 3.40;31.69± 5.01 vs.32.29 ± 5.31,all P > 0.05).(2)Dissimilarity analyses and univariate logistic regressions showed that diameter and number of tophi by ultrasound,family history of gout,age,duration of gout,combined hyperlipidemia,glutaminase,transaminase and glutamyl transpeptidase levels were factors that might affect the limitation of MTP1 mobility,diameter and number of tophi by ultrasound,joint effusion,macroscopic tophi,glomerular filtration rate,creatinine,high-density Lipoprotein level were factors that might affect the limitation of knee mobility.The above factors were included in multivariate logistic regression analyses showing that the diameter of tophi and age were risk factors for limited mobility of MTP1(OR: 3.213,1.056;P: 0.006,0.006)and the number of tophi in the joint was risk factor for limited knee mobility(OR: 10.276,P: 0.007).ROC analyses manifested the good predicative performance of the diameter of tophi for joint motion limitation of MTP1 and the number of tophi for limited knee motion [AUC(95%CI): 0.747(0.662-0.832),0.843(0.701-0.985)].2.Analyses of data at 6 months follow-up compared to baseline and exploration of potential influencing factors:(1)There was a significant improvement in the mobility of the MTP1 in both dorsiflexion and abduction directions after treatment compared with baseline(55.55± 12.45 vs.58.46 ± 11.44,17.12 ± 3.81 vs.18.23 ± 2.89;P: 0033,0.007),but no significant change in the mobility of the affected joint in all directions was observed in the ankle and knee joints before and after treatment(all P > 0.05).(2)Univariate logistic regression analyses showed that the value of change(baseline after 6 months of treatment)in diameter of tophi(Δ diameter of tophi),age and family history of gout were factors that might influence the improvement of MTP1 mobility after treatment,and the multivariate logistic regression analysis Including above factors showed the value of Δ diameter of tophi was a contributing factor associated with the improvement of the mobility of MTP1(OR: 3.796.P: 0.002).ROC analysis showed good predictive efficacy of Δ diameter of tophi for improvement in MTP1 joint mobility [AUC(95% CI)= 0.724(0.619-0.829)].When Δ diameter of tophi was greater than 0.35 cm,joint mobility of MTP1 tends to improve.Conclusions:1.The joint mobility of MTP1 and knee was significantly affected by gout.A significant decrease was observed in joint mobility on the affected side of the MTP1 and knee compared to the healthy side.2.The diameter of tophi and age were risk factors that might lead to limited mobility of MTP1,and the number of tophi in joint was a risk factor that might cause limitation of knee mobility.3.The reduction in the diameter of intra-articular tophi in gout patients receiving long-term standardized treatment,which might be a critical factor promoting the improvement of MTP1 joint mobility. |
PDF Full Text Request