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

  • Zhe PENG ,
  • Ya-min DING ,
  • Lin PEI ,
  • Hai-hong YAO ,
  • Xue-wu ZHANG ,
  • Su-mei TANG
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  • 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 date: 2021-09-14

  Online published: 2021-12-13

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.

Cite this article

Zhe PENG , Ya-min DING , Lin PEI , Hai-hong YAO , Xue-wu ZHANG , Su-mei TANG . Clinical characteristics of crystal deposits in joints and tendons in patients with gout[J]. Journal of Peking University(Health Sciences), 2021 , 53(6) : 1067 -1071 . DOI: 10.19723/j.issn.1671-167X.2021.06.010

References

[1] Dalbeth N, Merriman TR, Stamp LK. Gout[J]. Lancet, 2016, 388(10055):2039-2052.
[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.
[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.
[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.
[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.
[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.
[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.
[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.
[14] Goldberg EL, Dixit VD. Drivers of age-related inflammation and strategies for healthspan extension[J]. Immunol Rev, 2015, 265(1):63-74.
[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.
[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.
[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.
[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.
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