痛風性關節炎病人骨骼肌肉超音波檢查發現與實驗室數據結果兩者的相關性

The Correlation between Musculoskeletal Ultrasonographic Findings and Laboratory Data of Gouty Arthritis

Objective: Gout is a common inflammatory arthritis caused by the deposition of monosodium urate(MSU) monohydrate crystals in joints. We investigated how musculoskeletal ultrasonography (MSKUS)contributed to detect gouty arthritis and monitor disease activity after treatment.Methods: This is a retrospective review of clinical manifestation and MSKUS changes in 171 consecutivepatients with gouty arthritis. All patients had their gout confirmed by the MSU crystal from the synovialfluid aspiration. The data were analyzed by Mann-Whitney U test or Phi coefficient test as appropriate, andp values < 0.05 were considered significant.Results: The joint effusion, synovial proliferation, tenosynovitis, Baker’s cyst, tophi, and the doublecontour (DC) sign were respectively detected in 93.0%, 50.3%, 29.8%, 18.7%, 14.6%, and 28.7% ofpatients. The patients with higher white cell count (WCC) in synovial fluid had lower risk of tenosynovitis (p= 0.04), Baker’s cyst (p = 0.04), and DC sign (p < 0.01). Patients with intraarticular tophi deposition hadlower serum uric acid level (p = 0.013). Patients exhibiting synovial proliferation had higher prevalence ofjoint effusion (p < 0.01) and Baker's cyst (p < 0.01), but lower prevalence of tenosynovitis (p < 0.01) andtophi (p = 0.016).Conclusion: MSKUS is a valuable tool for detectingstructural changes of joint or extra-articular spacein patients of gouty arthritis. Patients with chronicgouty arthritis characterised by Baker’s cyst, DCsign and tophi usually have received long-termtreatment and have less inflammation in synovium.Integrating clinical manifestations, MSKUS featuresand laboratory examinations helps guide physiciansevaluate inflammation in joints and prescribeadequate treatment for gouty arthritis. 目的：痛風是個常見的發炎性關節炎，由尿酸單鈉（monosodium urate, MSU）結晶沉積在關節所造成。本次研究的目的是為了比較痛風患者在骨骼肌肉超音波下的檢查發現彼此的相關性，以利監測痛風治療後的疾病活性或嚴重程度。方法：本次為回朔性研究，一共收集了171位痛風性關節炎病人的骨骼肌肉超音波下檢查結果。每位病人皆藉由關節液抽吸檢查發現MSU結晶而確定診斷。統計資料分析藉由Mann-Whitney U或是phi-coefficient方法分析，而p值小於0.05表示達顯著意義。結果：骨骼肌肉超音波發現93.0%病人有關節腔積液、50.3%有滑膜增生、29.8%有腱鞘炎、18.7%有貝克氏囊腫、14.6%有痛風石以及28.7%有雙輪廓徵象（double contour sign）。當病人關節液中白血球數目較高時，比較少機會看到腱鞘炎（p＝0.04）、貝克氏囊腫（p＝0.04）以及雙輪廓徵象（p＜0.01）。當病人發現關節腔痛風石，血中的尿酸濃度是較低的（p＝0.013）。另外當病人合併滑膜增生時，有較高機會看到關節腔積液（p＜0.01）和貝克氏囊腫（p＜0.01），但是反而較低機會發現腱鞘炎（p＜0.01）及痛風石（p＝0.016）。結論：骨骼肌肉超音波是個有效的工具去發現痛風性關節炎病人的關節腔內或外結構上的病變。當病人具有慢性痛風性關節炎相關表徵如貝克氏囊腫、痛風石以及雙輪廓徵象時，常接受長期治療可以減少關節腔滑膜的發炎。偕同骨骼肌肉超音波檢查發現以及實驗室檢查結果，可以更有效及正確的診斷痛風性關節炎病人關節腔內發炎的情況以及安排後續治療方針。