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OBJECTIVE@#To explore the abnormal manifestations and clinical features of patients with gout according to the location of crystal deposits: in articulars or in tendons.@*METHODS@#A total of 105 patients with gout who were continuously treated in the Department of Rheumatology and Immunology of Peking University People's Hospital from June 2019 to December 2019 were selected and their knees, ankles, toes and painful joints and tendons were examined by high-frequency ultrasound. Then we grouped them according to the presence or absence of sodium urate crystals and the location of the crystals, collected their clinical data, and analyzed the clinical characteristics.@*RESULTS@#Among the 105 patients, 25 patients had no crystal deposits in the joints or tendons (as the non-crystal group), 43 patients had intra-articular crystals (as the joint group), and 37 patients had intra-tendon crystals with or without intra-articular crystals (as the tendon group). Among them, the most involved part of sodium urate crystals deposited in the joints was the metatarsophalangeal joint (29 cases, 67.4%), followed by knee joints (10 cases, 23.2%), ankle joints (9 cases, 20.9%). The most involved part of sodium urate crystals deposited in the tendon was the quadriceps tendon (16 cases, 43.2%), followed by the Achilles tendon (13 cases, 35.1%), the patellar tendon (12 cases, 32.4%), and the three heads of brachii tendons (5 cases, 13.5%). The three groups were compared using multi-sample analysis of variance/multi-sample rank sum test. Age, age of first increase in uric acid (UA), serum glucose (Glu) level and C reactive protein (CRP) were all significantly different. After multiple comparisons, compared with the non-crystal group, age, the age of first increase in uric acid, and CRP were significantly higher in the tendon group. There was no significant difference between the non-crystal group and the joint group. There was no significant difference between the tendon group and the joint group.@*CONCLUSION@#In patients with gout, it is common for ultrasound to find crystals deposited in joints or tendons. The most commonly affected parts include the metatarsophalangeal joint, knee joint, ankle joint, quadriceps tendon, Achilles tendon, patellar tendon, and triceps tendon. There were significant differences among the three groups in age, age of first increase in uric acid, CRP and blood glucose, and the proportion of urinary calculi in patients with crystal deposits was significantly higher than those without crystal deposits.
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Humans , Achilles Tendon , Gout , Knee Joint , Metatarsophalangeal Joint/diagnostic imaging , Uric AcidABSTRACT
OBJECTIVE@#To explore the risk factors of detection of uric acid crystals by dual energy CT (DECT) in patients with gout diagnosed by gold standard.@*METHODS@#From June 2011 to December 2018, clinical data of 29 patients were collected who were diagnosed with acute or chronic gout by positive polarized light analysis of joint synovial fluid in First Hospital of Peking University. Chi-square test, Logistic regression and t-test were used. The relationship between DECT and the clinical data, laboratory examination and drug treatment were analyzed.@*RESULTS@#In this study, 29 patients were included, of whom, 22 patients were detected with uric acid crystals by DECT, and 7 patients were not. According to whether the uric acid crystals were detected or not by DECT, the patients were divided into two groups. Compared with the negative group, the patients were older in positive group [(47±12) vs. (39±11) years, P=0.15], had higher body bass index (BMI) [(27.9±3.7) vs. (22.8±2.1) kg/m2, P=0.002], longer gout disease duration [(135±102) vs.(45±53) months, P=0.035], higher in the highest serum uric acid in history [(643±121) vs. (543±103) μmol/L, P=0.043]. Although uric acid near DECT in positive group was higher than in negative group, there was no statistical difference [(558±150) vs. (513±89) μmol/L, P=0.497]. Comparing positive group with negative group, the percentage of the patients in acute phase was higher than in chronic phase [18(81.8%) vs. 4(57%), P=0.311];the percentage of the patients taking uric-acid-lowering drugs was higher than the other group [22(100%) vs. 5 (71%), P=0.052];the percentage of the patients with recurrent typical attacks was higher than that of those without typical attacks [22 (100%) vs.6 (85%), P=0.241]. The consistency of symptoms and the finding of uric acid crystals by DECT had been compared between the joints. The right knee joint had the highest consistency (Kappa=0.627), followed by the left MTP1 (Kappa=0.58), the right metatarsophalangeal 1(MTP1, Kappa=0.551) and the left knee (Kappa=0.494), all of which had statistical significance. The consistency of the ankle joint was lower (the right ankle joint: Kappa=0.19, the left ankle joint: Kappa=0.256), showing no statistical significance. BMI (kg/m2) [2.307 (1.139-4.670), P=0.02], gout duration (years) [0.306 (0.906-4.881), P=0.186], and the highest uric acid level in history (mg/dL) [0.023 (0.981-2.764), P=0.137] had relationship to the positive result of urate crystals in DECT.@*CONCLUSION@#Gout patients with larger BMI, higher previous highest uric acid value and longer gout duration had higher sensitivity of the positive result in DECT.
Subject(s)
Humans , Arthritis, Gouty , Gout/epidemiology , Risk Factors , Tomography, X-Ray Computed , Uric AcidABSTRACT
Gouty arthritis is caused due to the accumulation of uric acid crystals in joints which is the by-product of purinemetabolism in our body. The elevated level of uric acid in the blood is known as hyperuricemia that may resultsin deposition and inflammation of joints. This research experiment has examined the protective effect of Bacopamonnieri, an herb against the monosodium urate crystal-induced gouty arthritis in female Wistar albino rats. The ratswere divided into four groups with six rats in each group. Group-I was normal control rats, group-II rats were inducedwith monosodium urate crystal, group-III was administrated with B. monnieri in monosodium urate crystal-inducedrats, and group-IV was administrated with indomethacin in monosodium urate crystal-induced rats. The rats wereexamined for liver enzyme markers, antioxidant assays, and paw histopathology. The results of B. monnieri werecompared with that of standard drug indomethacin. The symptoms of arthritis, such as the elevation of paw volume,increased liver enzyme markers, decreased antioxidant enzymes, and histopathological changes, were found to bereversed to the normal level by the treatment with B. monnieri which is due to its anti-inflammatory properties. Asconclusion, B. monnieri has shown its anti-arthritic properties against gouty arthritis.
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Objective To assess the clinical value of dual-energy CT (DECT) Volume software in quantitative analysis of urate crystals.Methods The DECT data of 60 gout patients based on the American College of Rheumatology diagnostic criteria were analyzed retrospectively.The volumes of urate crystals were quantitatively analyzed by using Volume software with two senior radiologists.The results were statistically analyzed.Results Seventy-two joints of 60 gout patients were scanned by DECT.40 of 43 joints had urate crystals in foot and ankle with the average volume of (0.621±0.742) cm3;18 of 19 joints had urate crystals in knee with the average volume of (0.842±1.086) cm3;10 of 10 joints had urate crystals in hand and wrist with the average volume of (0.796±0.583) cm3.There was no statistical difference for volume measurement between two doctors (P>0.05).The volumes of urate crystals in 4 patients with regular medication were reduced.Conclusion Volume software of DECT can quantitatively analyze urate crystals with a good repeatability, which has high application value in clinical diagnosis and treatment monitoring of gout.
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Objective To evaluate the value of dual energy computed tomography (DECT) for the diagnosis of gout.Methods Twenty-fivc consccutive patients with gout were selected as the experimental group and 20 patients with rheumatoid arthritis (RA) were selected as the control group.DECT scans were performed for every patient (all peripheral joints for the experimental group and affected joints for the control group).And every patient with gout had X-ray examination of the involved joints.x2 test and t-test were used for statistical analysis.Results All 25 patients with gout showed urate deposits on their DECT scans,whereas none of 20 controls showed urate deposits (P＜0.01).DECT scans revealed a total of 184 areas of urate deposition in 25 patients,in which 107 (58.2％) were at feet and ankle,72 (39.1％) were at knees,4 (2.2％) were at hands and wrists,1 (0.5％) was at elbows,whereas physical examination only showed 64 areas of urate deposition,in which 38(59.4％) were at feet and ankle,24(37.5％) were at knees,2(3.1％) at hands and wrists,0 was at elbows(P＜0.01 ).Only 6 patients with gout showed nonspecific manifestations on X-ray.Conclusion DECT scans may have potential value for the diagnosis of gout since it could produce evident colour displays for urate deposits and help to identify subclinical tophus deposits.
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Objective To investigate the distribution of urate crystal as well as the relationship bet ween the features of the crystals and the attacks of joint pain and/or swollen by foot dual-energy CT.Methods Eight-four patients (68 were diagnosed as gout, 11 were patients with hyperuricemia and 5 were diagnosed as other types of arthritis) who recently experienced foot swelling and/or pain were enrolled and all of them were performed foot dual-energy CT.The relationship between the features of the urate crystals and the attacks of gouty arthritis was determined by Chi test and the potential risk factors were identified by Logistic multiple regression analysis.Results Two hundred and seventyeight urate crystal depositions were found in 68 gout patients,and the most common deposition sites were the distal parts of the first toe(18.2％),the first metatarso-phalangeal joint ( 16.8％ ),calcaneus ( 17.5％ ),the lower end of tibia ( 11.8％ ).Furthermore,patients with the urate crystals deposited in the first metatrasophalangeal joint or the lower end of of tibia were more likely to experience acute episodes of gout attack (P＜0.01,P＜0.05 respectively).In addition,the shape,size and quantity of urate crystals also affected episodes of acute attack of gout.Conclusion Dual-energy CT,which is a non-invasive method,could clearly reveal urate crystal depositions and is helpful for the diagnosis and follow-up of patients with gout.The location,shape,size and quantity of urate crystals and soft tissue swelling,bone erosion may affect the acute attack of gout.
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OBJECTIVE:To study the effect of the extracts of Paederia scandens (EPS) on acute gouty arthritis induced by monosodium urate in rats. METHODS: Monosodium urate crystals were used to establish gouty arthritis model in rats, with ankle joints' swelling degree at different time after modeling measured using paw volume measuring meter and gaits of rats scored at 24h after modeling. Pathological changes of articular tissues of rats were observed with HE staining and TNF-? and IL-1? levels were monitored by Radioimmunoassay. RESULTS:EPS could significantly inhibit joint swelling of rats and improve the gaits; histopathologically, EPS could abate tissue swelling of ankle joints, reduce inflammatory cell infiltration of articlar tissues and improve the pathological changes of synovial membranes. Radiommunoassay revealed that EPS could reduce levels of TNF-? and IL-1? in rats' synovial membranes. CONCLUSION:EPS have remarkable efficacy in improving symptoms of acute gouty arthritis induced by monosodium urate crystals in rats, which might be related to its inhibition on levels of IL-1? and TNF-?.