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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 735-739. doi: 10.19723/j.issn.1671-167X.2025.04.017

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Risk factors associated with non-radiographic bone erosion in patients with gout

Wei LIU1, Wen GUO2, Zhe GUO3, Chunyan LI4, Yunlong LI1, Siqi LIU1, Liang ZHANG5, Hui SONG1,*()   

  1. 1. Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    2. Department of Ultrasound, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    3. Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    4. Department of Laboratory Tests, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    5. Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
  • Received:2022-08-12 Online:2025-08-18 Published:2025-08-02
  • Contact: Hui SONG

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Abstract:

Objective: To analyze the factors associated with non-radiographic bone erosion in gout patients, to improve the understanding of bone erosion in gout, and to promote the early detection of bone erosion. Methods: A retrospective analysis was conducted on the medical records of gout patients treated at Beijing Jishuitan Hospital from January 2018 to January 2022. Bone erosion was detectable by ultrasound but not detected by X-ray as non-radiographic bone erosion; no bone erosion was detected by both ultrasound and joint X-ray as undetected bone erosion. A case-control study was used, and the two groups were matched 1 ∶ 2 according to age and sex. The differences between the two groups were compared in terms of general information, joint involvement characteristics, laboratory indicators and complications. In the univariate analysis, P < 0.1 was included in the multivariate analysis, and the conditional Logistic regression was used for the multivariate analysis. P < 0.05 was considered to have statistically significant differences. Results: Among the 41 patients with non-radiographic bone erosion, the top three joints with bone erosion before its occurrence were metatarsophalangeal joint (12 cases), ankle (10 cases), and knee (7 cases). There were 82 patients undetected with bone erosion. There were no significant differences in general information between the two groups (P>0.05), including age, gender, body mass index, and alcohol consumption history. The characteristics of affected joints in the non-radio-graphic bone erosion group were compared with those in the no bone erosion detected, and the former had more affected joints (P=0.02), and a higher proportion of patients with at least 3 attacks of gout per year (P < 0.001). There were no significant differences in serum uric acid, fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, creatinine, homocysteine, white blood cell count, and urine pH between the two groups (P>0.05). The results of multivariate analysis showed that at least 3 flares of gout per year was an independent risk factor for radiologically negative bone erosion in patients with gout, with an OR (95%CI) of 5.139 (1.529-17.271). Conclusion: At least 3 flares of gout per year predicts the occurrence of radiologically negative bone erosion, and these patients should be given more attention to achieving treatment targets.

Key words: Gout, Bone erosion, Ultrasound, X-rays, Risk factors

CLC Number: 

  • R589.7

Table 1

Comparison of general clinical characteristics between the two groups"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
Age/years 48 (33, 54) 49 (33, 53) 0.180
Gender 0.999
    Male 40 (97.6) 80 (97.6)
    Female 1 (2.4) 2 (2.4)
BMI/ (kg/m2) 27.7 (23.4, 29.4) 27.3 (24.8, 30.1) 0.674
Disease duration/years 6.0 (3.0, 10.0) 3.0 (0.9, 6.0) 0.020
Somking 20 (48.8) 44 (53.7) 0.006
Drinking 19 (46.3) 31 (37.8) 0.272
Family history 8 (19.5) 12 (14.6) 0.002

Table 2

Comparison of gout-involved joints between the two groups"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
Involved joint count 5 (2, 8) 3 (2, 4) 0.020
Flare counts per year≥3 31 (75.6) 39 (47.6) ＜0.001
Foot joint involvement 36 (87.8) 61 (74.4) ＜0.001
Ankle involvement 25 (61.0) 54 (65.9) ＜0.001
Knee involvement 23 (56.1) 45 (54.9) 0.001
Hand joint involvement 17 (41.5) 16 (19.5) 0.268
Elbow involvement 7 (17.1) 7 (8.5) ＜0.227
Tophi 7 (17.1) 7 (8.5) ＜0.227

Table 3

Comparison of laboratory indicators between the two groups"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
UA /(μmol/L) 498.9±146.6 538.4±141.0 0.282
GLU/ (μmol/L) 5.2 (4.9, 5.7) 5.3 (4.9, 5.7) 0.854
CHOL/(mmol/L) 4.8±1.0 4.9±1.1 0.898
TG/(mmol/L) 1.6 (1.3, 2.3) 1.9 (1.2, 2.8) 0.928
LDL/(mmol/L) 3 (2.6, 3.6) 3.3 (2.4, 3.8) 0.604
HDL/(mmol/L) 1.2±0.3 1.2±0.3 0.341
Cr/(μmol/L) 83 (74, 96) 81 (71, 94) 0.995
HCY/(μmol/L) 17.1 (13.2, 22.4) 17.1 (13.3, 24.8) 0.456
WBC/(×109/L) 8.1 (5.9, 10.4) 8.3 (7.0, 10.4) 0.496
pH 5.9 (5.5, 6.5) 5.5 (5.5, 6.0) 0.850

Table 4

Comparison of comorbidities between the two groups"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
Hypertension 21 (51.2) 45 (54.9) 0.003
Diabetes mellitus 3 (7.3) 11 (13.4) 0.382
Cardiovascular disease 1 (2.4) 2 (2.4) 0.999
Renal calculi 5 (12.2) 12 (14.6) 0.001

Table 5

Multivariate analysis of factors associated with non-radiographic bone erosion in gout patients"

Variable B SE Wald df P OR (95%CI)
Disease duration 0.085 0.054 2.448 1 0.118 1.088 (0.979-1.210)
Somking 0.113 0.472 0.057 1 0.811 1.119 (0.444-2.825)
Family history 0.406 0.597 0.462 1 0.497 1.501 (0.466-4.835)
Involved joint count 0.042 0.101 0.173 1 0.677 1.043 (0.855-1.272)
Flare counts per year≥3 1.637 0.618 7.006 1 0.008 5.139 (1.529-17.271)
Foot joint involvement 0.403 0.692 0.340 1 0.560 1.497 (0.386-5.807)
Ankle involvement -0.867 0.603 2.066 1 0.151 0.420 (0.129-1.371)
Knee involvement -0.334 0.557 0.360 1 0.549 0.716 (0.240-2.133)
Hypertension -0.211 0.481 0.191 1 0.662 0.810 (0.315-2.081)
Renal calculi -0.670 0.712 0.885 1 0.347 0.512 (0.127-2.066)
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