摘要

背景：超声是发现尿酸沉积有用的工具。根据EUALR推荐，痛风降尿酸治疗的指证为痛风反复发作、关节病、痛风石或放射线有骨破坏。超声可提供不满足EULAR降尿酸治疗指证标准患者的尿酸沉积严重性的重要信息。

目的：评价根据EULAR推荐不需降尿酸治疗的痛风患者超声下的尿酸沉积发生率。

方法：这是一项前瞻性研究，患者须满足如下标准：滑液中证实有尿酸盐结晶；急性发作3次以内；临床检查无痛风石；足部和（或）受累部位的放射学无骨破坏。由2位训练有素的风湿病大夫应用Esaote Technos MP超声仪对所有关节在长轴和背侧位进行扫描，膝关节同时进行横断面扫描。每位患者均行第一和第二跖趾关节、膝关节及第2和第三掌指关节的扫描。记录每一个关节（跖趾关节或膝关节或掌指关节)是否存在“双轮廓”征和痛风石。

结果 :12个月内共筛选了64例痛风患者，包括无降尿酸治疗指证的10例患者[平均年龄(60.7±17.4) 岁，9例男性]。共评估100个关节，第一次发作与超声评估间的平均时间为 (38.9±42.8)个月。每位患者急性发作平均数为（2±0.67），尿酸水平为（590±125） μM，肌酐清除率为（58±30）ml/min。50%的患者至少一个关节部位有“双轮廓”征，在掌指关节、膝关节和跖趾关节分别为10%、30%和40%。50%的患者至少有一个关节发现有痛风石，掌指关节、膝关节和跖趾关节分别为10%, 20%和30%。80%的有“双轮廓”的患者有痛风石。非参数分析发现，高尿酸血症与膝关节“双轮廓”征之间有相关性 (P=0.03)，我们也发现，痛风石与至少一个关节部位存在“双轮廓”征间有相关性(P=0.05)。

结论：超声可在一半的痛风早期患者中检测到尿酸盐结晶，超声发现尿酸沉积将引发何时开始降尿酸治疗最好的争论。

附原文：Background: Ultrasonography (US) emerges as a useful toll to detect urate deposition. According to the EULAR recommendations, urate-lowering therapy (ULT) is indicated only in gouty patients with recurrent attacks, arthropathy, tophi, or radiographic changes of gout [1]. US could provide important information on the severity of urate deposition in patients apparently not fulfilling Eular recommendations for ULT. Objectives: To assess by US the prevalence of urate deposits in recently diagnosed gouty patients who did not require ULT according to the Eular recommendations. Methods: To be included in this prospective study, patients had to fulfil the following criteria: gout proven by MSU crystal demonstration in synovial fluid, ≤ 3 acute attacks, no tophus at clinical examination, absence of radiologic features of gout at the foot and/or affected joint, absence of urate nephropathy. US was performed by two trained rheumatologists (SO and AA) using a Esaote Technos MP machine. All joints were scanned in longitudinal plane and dorsal side. Knees were also explored on transversal plane. The first and second metatarsophalangeal (MTP) joints, knees and the second and third metacarpophalangeal (MCP) joints were studied in each patient. For each articular site (MTP or knee or MCP), the presence or absence of the double-contour sign and tophus was recorded. Results: 64 gouty patients were screened during a 12 months period, and 10 patients (mean (SD) age 60.7±17.4 years, 9 males) with no indication for ULT were included in this study. A total of 100 joints were assessed. Mean delay between the first attack and US assessment was 38.9±42.8 months. The number of acute attacks per patient was 2±0.67. Urate level was 590±125 μM and clearance of creatinine was 58±30 ml/min. The double-contour sign was observed in at least one articular site in 50% of patients. It was found in the MCP, the knee and the MTP in 10%, 30% and 40% of cases, respectively. Tophi were also observed in at least one articular site in 50% of patients. They were found in the MCP, the knee and the MTP in 10%, 20% and 30% of cases, respectively. Tophi were detected in 80% of patients having a double-contour sign, and reciprocally. Using non parametric test, correlation was found between uricemia and the presence of the double-contour sign at the knee (P=0.03). We also found a correlation between the presence of tophus and the double-contour sign in at least one articular site (P=0.05). Conclusion: Ultrasonography allows detection of urate deposits in about half gouty patient at the early stage of the disease. Urate deposits detection by US in these patients raises the question of the best time to initiate ULT.

引自：S. Ottaviani, A. Allard, T. Bardin, et al. Ultrasonography findings in gouty patients not requiring urate lowering therapy according to the EULAR recommendations. Ann Rheum Dis 2010;69(Suppl3):123