Change of ultrasonographic signs during urate lowering therapy in patients with gout / 中国实用内科杂志

ABSTRACT

OBJECTIVE: To explore related factors of changes in gouty patients by ultrasonography after initiation of uric acid lowering therapy. METHODS: There were 72 gout patients enrolled who admitted to First hospital of Peking University from December 2012 to June 2017. All the patients had clinical and ultrasound examination at both knees, ankles and feet joints at the baseline. Regular uric acid lowering therapy started for one year. The endpoint was the last time who repeat the ultrasound examination during the follow up.According with uric acid level and its measuring time, the area under the curve was calculated to reflect the uric acid burden. RESULTS: In the 216 jonts of 72 patients, double contour sign were detectable in 112/216(51.85%), tophi were detectable in71/216(32.87%).Among MTP Joints, DCS was detected in 32/144(22.22%), and tophi in 47/144(32.64%). Among Knees joints, DCS was detected in 33/144(22.92%), tophi in 4/144(2.78%). Among ankle joints, DCS was detected in 47/144(32.64%), tophi in 20/144(13.89%).DCS disappearance occurred in 38/55(69.09%) joints positive for DCS at baselineTime-to-disappearance was 148 days(985～133 days). Tophi disappeared completely in 18/45 joints(40%). Time-to-disappearance was 382.5 days(686～397.25 days). There was no significant difference in age, BMI, duration of disease and complications between DCS persisted group and DCS disappearance group.SUA in the DCS disappeared group at baseline, second, third, fourth and ninth months of follow-up. was significantly lower than that of the non-disappeared group. SUA load in the DCS group was significantly lower than the non-disappeared group. Post hoc tests showed that SUA levels fell significantly from baseline through fourth month of follow-up in DCS disappearance group, and SUA of the sixth months was the lowest. CONCLUSION: To screen for specific features of gout such as DCS or tophi by US at initiation of ULT and during follow-up is a useful, and effective way to detect the lowering and often disappearance of burden of urate load in gouty joints.