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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)
1
徐东, 朱小霞, 邹和建, 等. 痛风诊疗规范[J]. 中华内科杂志, 2023, 62 (9): 1068- 1076.
2
Wu M , Liu FJ , Chen J , et al. Prevalence and factors associated with bone erosion in patients with gout[J]. Arthritis Care Res (Hoboken), 2019, 71 (12): 1653- 1659.
3
Liu X , Li B , Zhang X , et al. Factors associated with bone erosion in patients with gout: A dual-energy gemstone spectral imaging computed tomography study[J]. Mod Rheumatol, 2022, 32 (6): 1170- 1174.
4
Sapsford M , Gamble GD , Aati O , et al. Relationship of bone erosion with the urate and soft tissue components of the tophus in gout: A dual energy computed tomography study[J]. Rheumatology (Oxford), 2017, 56 (1): 129- 133.
5
Gutierrez M , Schmidt WA , Thiele RG , et al. International consensus for ultrasound lesions in gout: Results of Delphi process and web-reliability exercise[J]. Rheumatology (Oxford), 2015, 54 (10): 1797- 1805.
6
王少坤, 袁威玲, 李兴福, 等. 高频超声在类风湿关节炎早期诊断中的应用研究[J]. 中华风湿病学杂志, 2007, 11 (9): 544-546, 577.
7
田静, 陈进伟, 李芬, 等. 灰阶联合能量多普勒超声在评价早期类风湿关节炎骨侵蚀及疾病活动度中的应用价值[J]. 中南大学学报(医学版), 2013, 38 (12): 1270- 1274.
8
Christiansen SN , Filippou G , Scirè CA , et al. Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise[J]. Semin Arthritis Rheum, 2021, 51 (3): 644- 649.
9
Jia E , Li Z , Geng H , et al. Neutrophil extracellular traps induce the bone erosion of gout[J]. BMC Musculoskelet Disord, 2022, 23 (1): 1128.
10
Naot D , Pool B , Chhana A , et al. Factors secreted by monosodium urate crystal-stimulated macrophages promote a proinflammatory state in osteoblasts: A potential indirect mechanism of bone erosion in gout[J]. Arthritis Res Ther, 2022, 24 (1): 212.
11
Kondo Y , Kaneko Y , Takeuchi T , et al. Differential diagnosis of inflammatory arthritis from musculoskeletal ultrasound view[J]. Rheumatol Immunol Res, 2022, 3 (2): 54- 60.
12
Lu CC , Huang GS , Lee TS , et al. MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis[J]. J Transl Med, 2021, 19 (1): 298.
13
李英梅, 刘佳, 田哲, 等. 肌骨超声与MRI对类风湿性指关节炎的病情评估研究[J]. 中国CT和MRI杂志, 2022, 20 (3): 165- 167.
14
Sakaguchi S . Repair of bone erosion with effective urate-lowering therapy in a patient with tophaceous gout[J]. Arthritis Rheumatol, 2021, 73 (2): 231.
15
Dalbeth N , Billington K , Doyle A , et al. Effects of allopurinol dose escalation on bone erosion and urate volume in gout: A dual-energy computed tomography imaging study within a rando-mized, controlled trial[J]. Arthritis Rheumatol, 2019, 71 (10): 1739- 1746.
16
Ma L , Sun R , Jia Z , et al. Clinical characteristics associated with subcutaneous tophi formation in Chinese gout patients: A retrospective study[J]. Clin Rheumatol, 2018, 37 (5): 1359- 1365.
17
Chhana A , Callon KE , Pool B , et al. Monosodium urate monohydrate crystals inhibit osteoblast viability and function: Implications for development of bone erosion in gout[J]. Ann Rheum Dis, 2011, 70 (9): 1684- 1691.
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