膝关节痛风性关节炎的超声诊断价值

目的 探讨超声在痛风性关节炎诊断中的价值。方法 选取2015年3月~2018年12月我院确诊为痛风性关节炎且膝关节受累患者20例,均进行超声检查及关节镜检查,观察患者超声及关节镜下表现。结果 超声检查:声像图异常表现有滑膜增生、积液、尿酸结晶沉积、痛风石形成、“双轨征”、骨侵蚀,其中可见滑膜增生19例、积液15例、尿酸结晶沉积13例、痛风石形成5例、“双轨征”3例、骨侵蚀1例。关节镜检查:镜下可见大量白色尿酸盐结晶,沉积于关节腔内。结论 超声检查能有效、全面的评估痛风性关节炎患者受累关节情况,能够实时动态对不同病程阶段的关节情况进行监测,其可作为痛风性关节诊断的重要影像学手段。     

双能量CT对痛风性关节炎的诊断价值

目的:探讨双能量CT扫描对痛风性关节炎的诊断价值。方法:选取疑似痛风性关节炎患者91例,均给予双能量CT扫描。结果:金标准确诊痛风性关节炎71例,非痛风性关节炎20例;双能量CT诊断痛风性关节炎68例,非痛风性关节炎23例。双能量CT诊断痛风性关节炎的灵敏度、特异度、阳性预测值和阴性预测值分别为91.55%、85.00%、95.59%和73.91%;双能量CT对间歇慢性期痛风结节、骨质破坏的检出率分别为95.12%和65.85%,明显高于急性期(P0.05);双能量CT对尿酸值420μmol/L和≥420μmol/L患者痛风结节和骨质破坏检出率比较无统计学差异(P0.05)。结论:双能量CT扫描对痛风性关节炎有较好的诊断价值。     

芜湖地区痛风急性发作诱因及临床生化特征初探

目的 探讨痛风性关节炎急性发作的诱因并对其临床特征进行总结。方法 对2017年11月~2018年12月就诊于皖南医学院第二附属医院内分泌科门诊及住院痛风性关节炎急性发作患者进行问卷调查并收集临床资料,将以上资料录入Excel数据库,对其急性发作诱因及临床特征进行分析。结果 50~60岁为发病年龄高峰,女性患者均为绝经后发病;88.03%的痛风患者急性发作前有诱因,高嘌呤饮食诱发的为61例（52.14%）,因饮酒诱发的为55例（47.01%）,上述两者中至少含有一项者为81例（69.23%）,同时含有两项者为32例（27.35%）;60例患者首发关节部位为足第一跖趾关节,下肢关节受累数目多于上肢关节（113例vs 14例）。发病年龄小的患者比发病年龄大的患者痛风发作频率高;病程长,有痛风石的患者易痛风发作频率高（P均＜0.05）;血尿酸水平高低与患者发作频率无关,两组其他临床生化检查比较,差异无统计学意义（P＞0.05）;年龄、BMI、血尿素氮是痛风石形成的危险因素,频发与长病程同样是痛风石形成的危险因素,差异均有统计学意义（P＜0.05）;Pearson直线相关分析发现:痛风急性发作时血尿酸水平与血尿素氮、血肌酐、胱抑素C相关（P＜0.05）;多因素Logistic分析显示年龄、频发和长病程是痛风石形成的独立危险因素（P＜0.05）。结论 痛风患者中老年居多,发病存在明显性别差异。痛风性关节炎急性发作诱因中以高嘌呤饮食和饮酒为其最常见诱因;发病年龄小,病程长,有痛风石的患者发作频率高。部分痛风性关节炎急性发作时血尿酸水平并不高。年龄偏大、频发和长病程的患者容易形成痛风石。     

无高尿酸血症的急性痛风性关节炎的诊断方法的对比研究

目的 探讨双源CT和普通X线影像技术在急性痛风性关节炎的诊断准确性的对比研究.方法 用双源CT和X线对224例血尿酸在正常范围内的急性关节炎患者进行双源CT和X线等影像学检查,同时,对38例临床排除痛风的急性关节炎患者也进行双源CT和X线检查,评估痛风石的检出率.结果 224例血尿酸不高的患者,通过双源CT发现32例病人的肿痛关节周围有痛风石沉积,检出率为12.4％,而X线仅发现1例有痛风性骨侵蚀,检出率为1.8％,经卡方检验两种检查方法所得结果有统计学差异(x 2 =23.861,P＜0.001);而无痛风的对照患者,都未查出痛风石.结论 在血尿酸正常的急性关节炎患者,双源CT比X线更特异敏感地检测出痛风石.因此,对于血尿酸正常的急性痛风性关节炎患者需要进行双源CT检查,有重要的从而与其他急性关节炎鉴别.     

痛风合并类风湿关节炎5例临床观察

痛风是尿酸排泄减少或者嘌呤代谢紊乱引起的一类晶体性关节疾病，患者主要临床表现为急性复发性痛风性关节炎、慢性痛风性关节炎、痛风石、尿酸盐性肾病以及肾结石，严重的患者会导致关节活动障碍以及尿毒症。类风湿关节炎(RA)属于一种对称性、多发性的小关节病变，属于全身性的免疫系统疾病，主要累及双手、腕关节以及足关节等部位，少部分患者会累及到膝关节、髋关节等大关节，血清中能够发现类风湿因子(RF)、抗环瓜氨酸多肽(CCP)等自身抗体。痛风和类风湿关节炎的患者在临床上多常见，但是两者同时发病的相关报道有限。本文主要对5例痛风合并类风湿关节炎的患者进行分析，观察其临床特征以及漏诊原因，以此提高临床对这类患者的认知度。     

原发性痛风并发肾损害患者血尿酸和血肌酐水平分析

原发性痛风患者中约1%为次黄嘌呤-鸟嘌呤磷酸核糖转换酶缺陷所致,大多数病因不明,临床以痛风性关节炎为主要表现.肾脏损害是原发性痛风的常见并发症.本文对54例原发性痛风伴肾脏损害患者血尿酸﹑肌酐水平进行了检测分析,结果报道如下.     

早期诊断结核性脑膜炎的新方法:检测浓缩脑脊液中CFP-10和ESAT-6

目的:应用酶联免疫吸附试验检测浓缩的脑脊液中结核分枝杆菌特异性抗原培养滤液蛋白10(CFP10)和6000早期分泌性抗原靶(ESAT-6),评价其在结核性脑膜炎(TBM)早期诊断中的价值。方法:应用ELISA测定46例临床诊断为TBM和56例非TBM患者脑脊液原液及经透析袋浓缩10倍的脑脊液浓缩液中CFP10和ESAT-6。结果:TBM患者脑脊液原液CFP10检测敏感度为13.04%、特异度为100.00%,ESAT-6的敏感度为13.04%、特异度为100.00%;而浓缩液CFP10的敏感度为78.26%、特异度为96.42%,ESAT-6的敏感度为76.09%、特异度为98.18%。结论:应用反透析方法浓缩脑脊液,使用抗CFP10和ESAT-6 ELISA检测脑脊液CFP10和ESAT-6能显著提高其敏感度,是一种简单、快速早期诊断结核性脑膜炎的有效辅助方法。     

痛风患者血尿酸和炎性因子水平变化及相关性分析

目的 探讨痛风患者血尿酸水平以及炎性因子C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平的变化,并对其进行相关性分析。方法 选择2018年5月~2019年2月我院收治的52例痛风患者作为患者组,选取同期52名健康受试者作为对照组。检测两组受试者的血尿酸及CRP、IL-6、TNF-α的水平;采用Pearson相关分析评估血尿酸与炎性因子水平的相关性;采用ROC曲线法评估CRP、IL-6、TNF-α联合血尿酸对痛风诊断的曲线下方面积（AUC）、灵敏度和特异性。结果 患者组血尿酸、CRP、IL-6、TNF-α水平均高于对照组,差异具有统计学意义（P＜0.05）。血尿酸与CRP（r=0.193,P=0.050）、IL-6（r=0.225,P=0.021）、TNF-α（r=0.342,P=0.000）的水平均呈正相关关系。CRP、IL-6、TNF-α联合血尿酸水平诊断痛风的AUC面积分别为0.824（灵敏度为86.30%,特异性为67.30%）、0.811（灵敏度为80.40%,特异性为73.10%）、0.989（灵敏度为100.00%,特异性为96.20%）。结论 痛风患者升高的血尿酸水平可能与循环中的炎性因子密切相关,且炎性因子的水平对于痛风的诊断具有一定的指导意义。     

抗CCP抗体与RF联合检测在类风湿关节炎早期诊断中的意义

目的 探究抗CCP抗体与RF联合检测在类风湿关节炎早期诊断中的意义。方法 选取2017年11月~2018年11月我院收治的30例类风湿关节炎患者设为研究组,另选取同期进行健康体检者30例设为对照组,对两组进行抗CCP抗体与RF联合检测,并且分析抗CCP抗体、RF单独及两者联合检测的敏感性、特异性、阳性预测值和阴性预测值。结果 研究组抗CCP抗体阳性率96.67%、RF阳性率93.33%和两者联合检测阳性率86.67%均高于对照组的6.67%、3.33%及3.33%;研究组抗CCP抗体水平（78.65±14.33）U/ml和RF水平（314.22±20.56）IU/ml均高于对照组的（2.69±2.14）U/ml和（10.01±3.54）IU/ml（P＜0.05）。结论 对类风湿关节炎患者抗CCP抗体与RF的诊断敏感度拥有着一定的相似性,但抗CCP抗体特异度高于RF的特异度,若两者联合检测可极大提高敏感度,对于类风湿关节炎患者早期诊断工作的开展拥有着积极的推动作用。     

高频超声对痛风性关节炎关节损害患者的诊断作用

目的探讨高频超声在痛风性关节炎关节损害中的诊断价值。方法 60例痛风性关节炎患者作为观察组, 58例非痛风性关节炎患者作为对照组,比较与分析两组患者的高频超声特点。结果观察组患者的双轨征、暴风雪样征、痛风石等指标发生率均明显高于对照组,各项数据组间统计学差异显著(P0.05);两组患者的滑膜增生、软组织水肿、关节腔积液、血流等指标比较统计学差异不显著(P0.05)。观察组患者中,急性期痛风性关节炎患者的痛风石、肌腱内点及团状强回声指标阳性率小于慢性期患者,而血流发生率则高于慢性期患者,各数据组间统计学差异显著(P0.05)。结论高频超声在痛风性关节炎的诊断中具有显著的临床应用价值。     

Caspase-1 Level in Synovial Fluid Is High in Patients with Spondyloarthropathy but Not in Patients with Gout

Activation of caspase-1 by NALP3 inflammasomes has been shown to be important in initiating acute gouty arthritis. The objectives of this study were to measure the levels of caspase-1 in synovial fluid in gout and various arthritides, and to elucidate the clinical significance of caspase-1 levels in synovial fluid. Caspase-1, IL-1β, IL-18, and uric acid were measured in synovial fluid from 112 patients with gout and other arthritides, such as rheumatoid arthritis, osteoarthritis, and spondyloarthropathy. Caspase-1 in synovial fluid from patients with crystal-induced arthritis, inflammatory arthritis, osteoarthritis, and spondyloarthropathy was 35.9 ± 86.7, 49.7 ± 107.7, 2.1 ± 7.0, and 152.6 ± 155.7 pg/mL, respectively. The mean level and the frequency of high levels (≥125 pg/mL) of caspase-1 in spondyloarthropathy were significantly higher than those in the other arthritides including gout. Caspase-1 was detectible in the synovial fluid of patients with the various arthritides. Contrary to our hypothesis, the caspase-1 level in the synovial fluid of patients with gout was not higher than in that of other arthritides. High levels of caspase-1 may be helpful in differentiating spondyloarthropathy from other arthritides.     

Chuanhu Anti-Gout Mixture versus Colchicine for Acute Gouty Arthritis: A Randomized,Double-Blind,Double-Dummy,Non-Inferiority Trial

Background The Chuanhu anti-gout mixture has been used for many years in the treatment of gout in Chinese Traditional Medicine, and current methods for treatments for acute gouty arthritis have been either less effective or have had serious side effects.Methods In this 12-week, double-blind, double-dummy, non-inferiority study, outpatient individuals with newly diagnosed acute gouty arthritis were randomly assigned to receive Chuanhu anti-gout mixture or colchicine. Both the study investigators and the participants were masked to the treatment assignments. The primary outcome was the recurrence rate of acute gouty arthritis, and the secondary outcomes were changes in white blood cells (WHC) and C-reactive protein (CRP). This trial is registered at ISRCTN.org as trial ISRCTN65219941.Results A total of 176 patients were randomly assigned to receive either the Chuanhu anti-gout mixture or Colchicine. The overall recurrence rates in the Chuanhu anti-gout mixture group (CH group) and the Colchicine group (Col group) were 12.50% vs 14.77% (difference -2.22%, 95% confidence interval (95% CI): -10.78%~6.23%), meeting the predefined non-inferiority criterion of 15%, as did the data for WHC and CRP. The incidence of adverse events (mainly diarrhea) was less in the Col group than in the CH group (2.27% vs 28.41%, 95% CI 0.01~0.26). In addition, changes in blood uric acid, alanine aminotransferase, aspartate aminotransferase and creatinine in the CH group were significantly larger compared to those in the Col group (P<0.05).Conclusions The Chuanhu anti-gout mixture was non-inferior to colchicine for the treatment of acute gouty arthritis. The study suggested that the Chuanhu anti-gout mixture can be considered an alternative choice for the treatment of acute gouty arthritis because of its lower incidence of adverse events and its protection of kidney and renal function.     

Seasonality of Gout in Korea: A Multicenter Study

The object of this study was to evaluate the seasonality of gout in Korea. We retrospectively examined data from 330 patients seen at nine rheumatology clinics, treated with urate lowering therapy (ULT) more than one year after stopping prophylactic medication. Demographic data, clinical and laboratory features, and seasonality of gout onset and flares were collected. Season was classified in three-month intervals. The mean age was 52.2 yr and mean disease duration was 26.8 months. The male to female count was 318:12. The onset of acute gouty attacks was obtained in 256 patients. Gout developed most commonly in summer season (36.7%) (P<0.001) and in June (15.6%, P=0.002). During ULT, there were 147 (male 97.3%) gout flares. Although there was no statistically significant difference, gout flares were more common in summer (30.6%). Aggravating factors were identified in 57 flares: alcohol (72.0%) was most common. In the patients who attained target serum uric acid (<6 mg/dL) at the end of prophylaxis, gout flares were high in fall (35.8%) and September (17.0%). In Korea, the summer is most common season of gout onset and there is a tendency for gout flares to increase during ULT in summer/fall season.

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Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis

Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to < 8) and low probability (≤ 4). In this retrospective study, we applied this diagnostic rule to 136 patients who presented as acute monoarthritis and were subsequently diagnosed as acute gout (n = 82) and septic arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P < 0.001). Patients with acute gout had significantly more ''high'', and less ''low'' probabilities compared to those with septic arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.

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Four-Week Effects of Allopurinol and Febuxostat Treatments on Blood Pressure and Serum Creatinine Level in Gouty Men

The aim of this study was to observe the effects of uric acid lowering therapy (UALT), febuxostat and allopurinol, on blood pressure (BP) and serum creatinine level. Post-hoc data were derived from a phase-III, randomised, double-blind, 4-week trial of male gouty patients that compared the safety and efficacy of febuxostat and allopurinol in adults with gout. The subjects were randomly assigned to one of five groups, 35-37 in each group (febuxostat: 40, 80, 120 mg/d; allopurinol: 300 mg/d; control group: placebo). Blood pressure and serum creatinine level were measured at baseline and at weeks 2 and 4. Diastolic BP and creatinine level had decreased significantly in the UALT groups compared to the control group at week 4. Diastolic BP had decreased significantly in the allopurinol group and serum creatinine level had decreased significantly in the febuxostat groups at week 4. After adjusting for confounding variables, serum uric acid changes were found to be significantly correlated with changes in serum creatinine level but were not associated with changes in systolic or diastolic BP. UALT in gouty subjects significantly decreased diastolic BP and serum creatinine level. Changes in uric acid were significantly correlated with those in serum creatinine level, suggesting the feasibility of renal function improvement through UALT in gouty men.     

Mechanisms of uric acid crystal-mediated autoinflammation

Summary: Gout is an arthritis characterized by elevated uric acid in the bloodstream. In this condition, crystals of uric acid are formed and accumulate in the synovial fluids. Crystal deposition leads to acute inflammation, which is associated with the spontaneous resolution of the disease. Recent studies have led to significant advances in the understanding of the basic biology of crystal-mediated inflammation. Uric acid has been identified as a danger signal that triggers a cytosolic sensor, the inflammasome. This signaling platform is required for the activation of interleukin-1, a cytokine that is critical to the initiation of acute inflammation in gout. Importantly, both molecular and pathological evidence support the notion that gout is a prototypical member of the growing family of autoinflammatory diseases. This review discusses the role of the inflammasome in gout and the emerging new therapeutic strategies aimed at controlling inflammation in crystal arthritis.     

质子泵抑制剂治疗上消化道出血对痛风复发的影响

目的 通过观察上消化道出血的痛风患者使用质子泵抑制剂（PPI）治疗前后临床症状及尿酸的变化,以探讨PPI治疗上消化道出血对痛风复发的影响。方法 选择我院上消化道出血合并原发性痛风患者37例为痛风组,同期37例上消化道出血且无痛风患者为对照组。两组患者在使用PPI前后分别监测尿酸、体温、关节肿痛等指标,并对相关指标进行统计学分析。结果 痛风组使用PPI后血尿酸较用药前升高（49.24±111.49）μmol/L,差异有统计学意义（P＜0.05）;对照组PPI使用后血尿酸较用药前升高（2.89±47.87）μmol/L,但差异无统计学意义（P＞0.05）。痛风组用药前后尿酸变化差值大于对照组,差异有统计学意义（P＜0.05）。使用PPI治疗后,痛风组64.86%出现非感染性发热,75.68%出现新发关节疼痛,患者疼痛评分较用药前增加（P＜0.001）,而对照组患者未出现关节痛及发热病例。结论 上消化道出血的痛风患者使用PPI可能诱发或加重痛风疾病的活动。