Background/Purpose: Gouty arthritis, caused by the deposition of monosodium urate (MSU) monohydrate crystals at joints, is comprised of multiple inflammatory processes in synovium, tendons, cartilages and bone. In addition to traditional serum tests including c reaction protein (CRP), erythrocyte sedimentation rate (ESR), uric acid and blood white cell counts, musculoskeletal ultrasonography (MSKUS) is a convenient, costless and straightforward tool to identify anatomical location and severity of inflammation, which guided clinicians appropriate treatment. Here, we retrospectively investigated how rheumatologists applied MSKUS in detecting and treating acute and chronic tophaceous gouty arthritis. We further analysed serum inflammatory markers, biochemistric results and blood cell counts and compared MSKUS manifestations to identify whether renal insufficiency influenced uric acid deposition at joints of patients with gouty arthritis.

Methods: This is a retrospective review of clinical and ultrasonographic findings in 280 patients with gouty arthritis from August 2004 to May 2017. All patients met the criteria of 2015 American College of Rheumatology/European League Against Rheumatism. Ultrasonographic manifestations include joint effusion, synovial proliferation, tenosynovitis, Baker’s cyst, double contour sign (DCS), and tophi-like lesion (TLL). Patients received blood tests including serum white blood cell count (WCC), serum uric acid, CRP, ESR, estimated glomerular filtration rate (eGFR) and we collected synovial fluid WCC from arthritis sites. Differences were analysed by independent t tests, phi coefficient, Pearson correlation coefficient and Cramer’s V Coefficient.

Results: Joint effusion, synovial proliferation, tenosynovitis, Baker’s cyst, DCS, and TLL were detected in 75.7%, 45.3%, 20.0%, 9.2%, 42.8% and 23.9% of joints, respectively. Patients with acute gouty arthritis and leucocytosis would have higher serum CRP (p < 0.01). Patients with synovial proliferation, tenosynovitis, or DCS had lower synovial fluid WCC (p = 0.04, 0.04, and < 0.01, respectively). Patients with synovial proliferation had higher prevalence of joint effusion, Baker’s cyst and double contour sign (p < 0.01, < 0.01, and < 0.01, respectively). Patients with TLL had lower serum UA (p =0.013). Patients with renal insufficiency (eGFR< 90) were characterized by higher prevalence of Baker’s cyst (p =0.02).

Conclusion: We would recognize Baker’s cyst, DCS, and TLL as MSKUS manifestations of chronic gout. Synovial proliferation and tenosynovitis can exist in both acute or chronic gouty arthritis. Synovial proliferation was considered as a transformational change between acute and chronic gout. Patients with chronic kidney disease have an increasing risk of development of Baker’s cyst. Early treatment of patients with gouty arthritis and chronic kidney disease help prevent development of chronic joints destructions.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/apply-musculoskeletal-ultrasonography-to-predict-chronic-gouty-arthritis-in-patients-with-chronic-kidney-diseases/