Background/Purpose: Musculoskeletal ultrasonography (US) is an invasive method to identify gout related bone damage, while Dickkopf-1 (DKK-1) and receptor activator of nuclear factor-κB ligand（RANKL）are bone remodeling factors associated with bone destruction. The association between bone remodeling factors and US is unknown and the role of ultrasonography in the evaluation of response to treatment needs to be further explored.

Methods: To evaluate the association between DKK-1, RANKL and US manifestations in patients with gout and hyperuricemia, and to clarify the role of ultrasonography on disease monitor and treatment responsiveness.

Results:

(1) Gout patients were divided into three groups according to US manifestations: normal group, aggregates and/or double contour signs group, tophus and/or bone erosion group. Similarly, patients with hyperuricemia were classified into two groups: normal US group, abnormal US group (at least one of the following manifestations, i.e. aggregate, double contour signs, tophus or bone erosion). Levels of DKK-1 and RANKL of gout patients with US-evidenced aggregates and/or double contour signs was higher than that of normal US group. Gout patients with tophus and/or bone erosion had the highest levels of DKK-1 and RANKL (P < 0.001). (2)The levels of DKK-1 and RANKL in hyperuricemia patients with abnormal US were significantly higher than that of normal US hyperuricemia patients. (3) After one year ULT, US abnormalities disappeared in 12 gout patients and 8 hyperuricemia patients. Besides, the diameter of the largest tophus was shortened after treatment in patients with gout (t=6.092, P<0.001）. Moreover, the concentrations of serum DKK-1 and RANKL significantly decreased after treatment for both gout and hyperuricemia patients. The lower the serum urate level was, the higher ratio of the normal US feature was in patients with gout and hyperuricemia. The levels of DKK-1 and RANKL, respectively, were positively correlated with the disease duration in both patients with gout (r=0.430, P<0.001; r=0.359, P<0.001) and hyperuricemia (r=0.446, P<0.001; r=0.379, P<0.001).

Conclusion: In patients with gout and hyperuricemia, musculoskeletal ultrasonography is remarkably associated with levels of DKK-1, RANKL, and ameliorates after ULT. Thus, US could be a useful tool on reflecting bone remodeling and monitoring disease responsiveness to treatment.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-musculoskeletal-ultrasonography-and-bone-remodeling-markers-and-the-role-of-ultrasonography-on-monitoring-treatment-responsiveness-in-patients-with-gout-and-hyperuricemia/