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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (1): 143-149. doi: 10.19723/j.issn.1671-167X.2021.01.022

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Risk factors and diagnostic value for ultrasound-detected tendon monosodium urate crystal deposition in patients with gout

WANG Yu,DENG Xue-rong,JI Lan-lan,ZHANG Xiao-hui,GENG Yan,ZHANG Zhuo-li()   

  1. Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
  • Received:2020-09-11 Online:2021-02-18 Published:2021-02-07
  • Contact: Zhuo-li ZHANG E-mail:zhuoli.zhang@126.com
  • Supported by:
    National Natural Science Foundation of China(81771740)

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Abstract:

Objective: To evaluate frequency and patterns, risk factors of MSU (monosodium urate) crystal deposition at lower extremity tendon by ultrasonography in gout patients, and to explore diagnostic value by ultrasonography.Methods: Patients diagnosed with gout and age matched healthy controls had ultrasound scanning of both feet and knees including joints and tendons (achilles, quadriceps, and patellar tendon). Readers who scored the ultrasound scans for MSU crystal deposition were blinded to the patients’ clinical diagnoses. Clinical characteristics were compared between positive and negative crystal deposition groups by US, and risk factors of MSU deposition in tendons were analyzed. Diagnostic values of MSU deposition were evaluated by ultrasonography according with positive MSU crystal in synovial fluid or tophi by polarized microscopy.Results: Eighty patients and eighty healthy controls were included. Thity-three patients (47.5%) had tophi by physical examination. The achilles tendon was the most commonly involved tendon site 41(51.2%), followed by the quadriceps tendons 22(27.5%), and patella tendon 10(12.5%). There were no MSU deposition in healthy control group at tendon by ultrasonography. Compared with negative MSU deposition at tendon site by ultrasonography, tendon MSU positive patients had longer mean gout duration [(87.3±40.9) months vs. (7.7±2.6) months, P=0.001];higher frequency of gout flare [2(1, 2) /year vs. 1(1,1) /year, P=0.001]; higher BMI [(26.3±2.5) kg/m2vs. (23.3±2.1) kg/m2, P=0.05]. Also, the mean serum uric acid and creatinine levels were higher in tendon MSU positive group [(584.6±87.6) μmol/L vs. (460.4±96.7) μmol/L, P=0.001] and [(90.9±33.3) μmol/L vs. (70.6±40.2) μmol/L, P=0.02] separately. Logistic regression analysis showed gout duration and flare frequency were independent risk factors for MSU deposition at tendon by ultrasonography (P<0.01). Joint or tophi aspirations were performed in all the eighty gout patients, and positive MSU crystals in synovial fluid analysis by polarized microscopy were defined as the golden standard of gout diagnosis. When compared with the golden standard, the sensitivity and specificity were 94.0% and 78.0% separately for MSU deposition at tendon by ultrasonography. Conclusion: Tendon involvement at the lower extremity tendons in gout is very common. Long gout disease duration and high frequency of gout flare are both independent risk factors of tendon MSU deposition by ultrasonography. Ultrasonography had good sensitivity and specificity for detecting tendinous tophi and aggregates.

Key words: Gout, Tendon, Sodium urate monohydrate, Ultrasonography, Diagnostic value

CLC Number: 

  • R589.7

Table 1

Demographics and clinical and laboratory findings in gout patients and control group"

Items Gout Control P
n 80 80
Age/years 56.3±13.4 55.6±10.3 0.548
Male/% 90 80 0.606
Disease duration/months 71.5±48 NA
Gout flare frequency(/year) 1(1,2) NA
BMI/(kg/m2) 28.2±6.1 22.8±7.1 0.001
Serum uric acid/(μmol/L) 596.3±117.2 323.7±96.3 0.001
Serum creatinine/(μmol/L) 81.3±38.3 76.4±31.7 0.672
hsCRP/(mg/L) 12.5±3.2 3.6±1.1 0.005

Table 2

Features of MSU deposition by ultrasound in gout patients and normal control group"

Items Gout Control P
n 80 80
Double contour sign, n(%) 10 (12.5) 0/80 (0) 0.001
Tophi N, n(%) 50 (62.5) 0 (0) 0.001
Intratendinous hyperechoic
aggregates, n(%)		 26 (32.5) 0 (0) 0.001
Intratendinous tophus, n(%) 44 (55.0) 0 (0) 0.001

Table 3

Sites of tendon involvement in gout patients"

Items Achilles tendon Quadriceps Patellar tendon
Intra-tendinous tophi, n(%) 32 (40.0) 14 (17.5) 6 (7.5)
Hyperechoic aggregates, n(%) 9 (11.3) 8 (10.0) 4 (5.0)
Power Doppler signal, n(%) 3 (3.7) 10 (12.5) 4 (5.0)

Table 4

Demographic and characteristics of gout patients with MSU deposition in tendon by ultrasonography"

Items Positive MSU deposition by US Negative MSU deposition by US P
n 44 36
Age/years, x-±s 53.8±9.8 49.2±12.1 0.217
Male, n(%) 40 (91) 34 (94) 0.871
Disease duration/months, x-±s 87.3±40.9 7.7±2.6 0.001
Gout flare frequency(/year), M(P25, P75) 2 (1,2) 1 (1,1) 0.001
BMI/(kg/m2), x-±s 26.3±2.5 23.3±2.1 0.05
Serum uric acid/(μmol/L), x-±s 584.6±87.6 460.4±96.7 0.001
Serum creatinine/(μmol/L), x-±s 90.9±33.3 70.6±40.2 0.02
hsCRP/(mg/L), x-±s 13.8±4.2 12.8±3.2 0.601

Table 5

Sensitivity, specificity and diagnostic odds ratio of US at detecting MSU crystal deposits at joint or tendon level"

Items Sensitivity (95%CI) Specificity (95%CI) Diagnostic odds ratio
Tendon tophi or aggregates 0.94 (0.77-0.99) 0.78 (0.63-0.88) 4.16 (2.45-7.06)*
Tendon tophi 0.87 (0.69-0.95) 0.82 (0.67-0.90) 4.74 (2.59-8.69)*
Tendon aggregates 0.63 (0.44-0.79) 0.76 (0.62-0.86) 2.63 (1.50-4.63)*
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