Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1067-1071. doi: 10.19723/j.issn.1671-167X.2021.06.010

Previous Articles     Next Articles

Clinical characteristics of crystal deposits in joints and tendons in patients with gout

PENG Zhe1,DING Ya-min1,PEI Lin2,YAO Hai-hong1,ZHANG Xue-wu1,TANG Su-mei1,△()   

  1. 1. Department of Rheumatology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Laboratory Medicine, Peking University People’s Hospital, Beijing 100044, China
  • Received:2021-09-14 Online:2021-12-18 Published:2021-12-13
  • Contact: Su-mei TANG E-mail:tangsumei@hotmail.com

RICH HTML

   

PDF (PC)

Abstract:

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.

Key words: Gout, Tendon, Joint, Sodium urate crystal deposition, Ultrasound

CLC Number: 

  • R59

Table 1

Basic conditions and uric acid levels of patients in each group"

Items Non-crystal (n=25) Tendon (n=37) Joint (n=43) P
Age/years 33.6±9.1 45.9±14.0a 41.1±12.7 0.001
BMI/(kg/m2) 26.5±3.2 27.4±4.2 25.9±3.8 0.246
Course of hyperuricemia/months 60.2±45.3 101.7±75.7 90.0±66.9 0.136
Age of first rise in UA/years 28.6±9.0 38.5±12.7a 34.5±10.6 0.004
Initial UA/(μmol/L) 540.4±78.3 564.5±175.7 526.2±65.2 0.649
Highest UA/(μmol/L) 604.8±65.5 632.6±130.0 607.7±101.6 0.627
Immediate UA/(μmol/L) 511.0±129.8 502.4±110.2 507.6±120.0 0.964

Table 2

Erythrocyte sedimentation rate and C reactive protein in each group"

Items Non-crystal (n=25) Tendon (n=37) Joint (n=43) P
ESR/(mm/h) 4.0 (3.0, 5.0) 8.0 (5.5, 25.0) 6.0 (4.0, 34.0) 0.244
CRP/(mg/L) 1.0 (0.8, 3.1) 5.3 (2.5, 11.8)a 9.4 (1.5, 19.0) 0.045

Table 3

Blood lipid and blood glucose in each group"

Items Non-crystal (n=25) Tendon (n=37) Joint (n=43) P
Glu/(mmol/L) 4.94±0.51 5.36±0.78 5.37±0.56 0.041
LDL-C/(mmol/L) 3.03±0.70 3.09±0.82 3.12±0.60 0.912
HDL-C/(mmol/L) 1.14±0.20 1.02±0.20 1.10±0.21 0.131
CHO/(mmol/L) 4.75±1.11 4.91±0.91 4.87±0.80 0.831
TG/(mmol/L) 2.14±1.18 2.33±1.39 2.19±1.48 0.867
[1] Dalbeth N, Merriman TR, Stamp LK. Gout[J]. Lancet, 2016, 388(10055):2039-2052.
doi: S0140-6736(16)00346-9 pmid: 27112094
[2] Neogi T, Jansen TL, Dalbeth N, et al. 2015 Gout classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Ann Rheum Dis, 2015, 74(10):1789-1798.
doi: 10.1136/annrheumdis-2015-208237
[3] Liu R, Han C, Wu D, et al. Prevalence of hyperuricemia and gout in mainland China from 2000 to 2014: A systematic review and meta-analysis[J/OL]. Biomed Res Int, 2015, 2015: 762820[2021-06-01]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657091/.
[4] Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: Prevalence, incidence, treatment patterns and risk factors[J]. Nat Rev Rheumatol, 2020, 16(7):380-390.
doi: 10.1038/s41584-020-0441-1 pmid: 32541923
[5] Fisher MC, Rai SK, Lu N, et al. The unclosing premature mortality gap in gout: A general population-based study[J]. Ann Rheum Dis, 2017, 76(7):1289-1294.
doi: 10.1136/annrheumdis-2016-210588 pmid: 28122760
[6] Doherty M, Jansen TL, Nuki G, et al. Gout: Why is this curable disease so seldom cured[J]. Ann Rheum Dis, 2012, 71(11):1765-1770.
doi: 10.1136/annrheumdis-2012-201687
[7] Wang Y, Deng X, Xu Y, et al. Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography: A cross-sectional study in patients with clinically diagnosed gout[J]. Medicine (Baltimore), 2018, 97(42):e12834.
doi: 10.1097/MD.0000000000012834
[8] Bayat S, Baraf HSB, Rech J. Update on imaging in gout: Contrasting and comparing the role of dual-energy computed tomography to traditional diagnostic and monitoring techniques[J]. Clin Exp Rheumatol, 2018, 114(5):53-60.
[9] Yuan Y, Liu C, Xiang X, et al. Ultrasound scans and dual energy CT identify tendons as preferred anatomical location of MSU crystal depositions in gouty joints[J]. Rheumatol Int, 2018, 38(5):801-811.
doi: 10.1007/s00296-018-3994-4 pmid: 29442150
[10] Naredo E, Uson J, Jiménez-Palop M, et al. Ultrasound-detected musculoskeletal urate crystal deposition: Which joints and what findings should be assessed for diagnosing gout[J]. Ann Rheum Dis, 2014, 73(8):1522-1528.
[11] 王昱, 邓雪蓉, 季兰岚, 等. 超声检测痛风患者肌腱受累的危险因素和诊断价值[J]. 北京大学学报(医学版), 2021, 53(1):143-149.
[12] Andia I, Abate M. Hyperuricemia in tendons[J]. Adv Exp Med Biol, 2016, 920:123-132.
[13] Thampatty BP, Li H, Im HJ, et al. EP4 receptor regulates collagen type-I, MMP-1, and MMP-3 gene expression in human tendon fibroblasts in response to IL-1 beta treatment[J]. Gene, 2007, 386(1/2):154-161.
doi: 10.1016/j.gene.2006.08.027
[14] Goldberg EL, Dixit VD. Drivers of age-related inflammation and strategies for healthspan extension[J]. Immunol Rev, 2015, 265(1):63-74.
doi: 10.1111/imr.12295 pmid: 25879284
[15] Alberts A, Klingberg A, Wessig AK, et al. C-reactive protein (CRP) recognizes uric acid crystals and recruits proteases C1 and MASP1[J]. Sci Rep, 2020, 10(1):6391.
doi: 10.1038/s41598-020-63318-8 pmid: 32286427
[16] Renaudin F, Orliaguet L, Castelli F, et al. Gout and pseudo-gout-related crystals promote GLUT1-mediated glycolysis that governs NLRP3 and interleukin-1β activation on macrophages[J]. Ann Rheum Dis, 2020, 79(11):1506-1514.
doi: 10.1136/annrheumdis-2020-217342
[17] Vazirpanah N, Ottria A, van der Linden M, et al. mTOR inhibition by metformin impacts monosodium urate crystal-induced inflammation and cell death in gout: A prelude to a new add-on therapy[J]. Ann Rheum Dis. 2019, 78(5):663-671.
doi: 10.1136/annrheumdis-2018-214656 pmid: 30814053
[18] Roughley MJ, Belcher J, Mallen CD, et al. Gout and risk of chronic kidney disease and nephrolithiasis: Meta-analysis of observational studies[J]. Arthritis Res Ther, 2015, 17(1):90.
doi: 10.1186/s13075-015-0610-9
[1] Xinfeng WU, Siliang MAN, Dazhao CHEN, Yong HUA, Xijie WEN, Yingyue DING, Liang ZHANG, Xiujuan HOU. A long-term review for radiographic parameters of hips in axial spondyloarthritis patients with end-stage hip involvement: A 24-year trend analysis from a single high-volume tertiary center [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1089-1095.
[2] Cuiping WANG, Zhe CHEN, Yongjing CHENG. Correlation study of superb microvascular imaging on knee osteoarthritis [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1096-1100.
[3] Wei LIU, Wen GUO, Zhe GUO, Chunyan LI, Yunlong LI, Siqi LIU, Liang ZHANG, Hui SONG. Risk factors associated with non-radiographic bone erosion in patients with gout [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 735-739.
[4] Yuanyuan FANG, Fan XU, Jie LEI, Hao ZHANG, Wenyu ZHANG, Yu SUN, Hongxin WU, Kaiyuan FU, Weiyu MAO. Development and validation of a clinical automatic diagnosis system based on diagnostic criteria for temporomandibular disorders [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 192-201.
[5] Wenjing LI,Baozhou ZHANG,Heng LI,Liangpeng LAI,Hui DU,Ning SUN,Xiaofeng GONG,Ying LI,Yan WANG,Yong WU. Tibiotalocalcaneal arthrodesis for end-stage ankle and hindfoot arthropathy: Short- and mid-term clinical outcomes [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 299-306.
[6] Hongguang LI,Weihua HAN,Xun WU,Jiling FENG,Gang LI,Juanhong MENG. Preliminarily study of arthrocentesis combined with liquid phase concentrated growth factor injection in the treatment of unilateral temporomandibular joint osteoarthritis [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 338-344.
[7] Da-wei WANG,Hua-dong WANG,Li LI,Xin YIN,Wei HUANG,Ji-dong GUO,Ya-feng YANG,Yi-hao LIU,Yang ZHENG. Efficacy analysis of autologous facet joint bone block in lumbar interbody fusion of osteoporosis patients [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 899-909.
[8] Hong DONG,Li-min WANG,Zhi-qiang WANG,Yan-qing LIU,Xiao-gang ZHANG,Ming-ming ZHANG,Juan LIU,Zhen-bin LI. Diurnal differences in acute gout attacks: A clinical study of male gout patients [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 915-922.
[9] Zi-wei ZHANG,Yu-meng HUA,Ai-ping LIU. Joint association of depression symptoms and 10-year risk of ischemic cardiovascular disease with the cardiovascular disease in middle-aged and elderly people in China [J]. Journal of Peking University (Health Sciences), 2023, 55(3): 465-470.
[10] Yi-lin YE,Heng LIU,Li-ping PAN,Wei-bing CHAI. Periprosthetic gout flare after total knee arthroplasty: A misdiagnostic case report [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 362-365.
[11] Shi-kai XIONG,Wei-li SHI,An-hong WANG,Xing XIE,Qin-wei GUO. Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT [J]. Journal of Peking University (Health Sciences), 2023, 55(1): 156-159.
[12] Yang LIU,Fang CHENG,Yan-ling WANG,Xiang-yan AI,Zhen-hang ZHU,Fu-tao ZHAO. Diagnostic performances of salivary gland ultrasonography for Sjögren's syndrome [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1123-1127.
[13] Yu WANG,Hui-min ZHANG,Xue-rong DENG,Wei-wei LIU,Lu CHEN,Ning ZHAO,Xiao-hui ZHANG,Zhi-bo SONG,Yan GENG,Lan-lan JI,Yu WANG,Zhuo-li ZHANG. Diagnostic values of urinary citrate for kidney stones in patients with primary gout [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1134-1140.
[14] Shu-heng ZHAI,Pan-pan HU,Xiao-guang LIU. Intraoperative ultrasound assisted circumferential decompression for multilevel ossification of the posterior longitudinal ligament in thoracic vertebrae [J]. Journal of Peking University (Health Sciences), 2022, 54(5): 1021-1027.
[15] Xiao-wei XIE,Fen LI,Guang-hui LING,Xi XIE,Su-qing XU,Yi-yue CHEN. Development and clinical application of the health education knowledge assessment questionnaire for gout [J]. Journal of Peking University (Health Sciences), 2022, 54(4): 699-704.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd