痛风患者发生关节及肌腱内晶体沉积的临床特点

目的:探讨痛风患者发生关节及肌腱内晶体沉积的临床特点,为痛风的早期诊治提供依据。方法:选择2019年6—12月在北京大学人民医院风湿免疫科连续就诊的痛风患者共105例进行回顾性分析,应用高频超声技术检测其膝、踝、足趾及其他疼痛关节和肌腱,并依据其有无尿酸钠晶体沉积以及晶体沉积部位对其进行分组,收集临床资料,并分析各组临床特点。结果:105例患者中,未检测到关节或肌腱内晶体沉积的患者共25例(无结晶组), 检测到关节内结晶的患者共43例(关节组),检测到肌腱内结晶(伴或不伴关节结晶)的患者共37例(肌腱组)。其中关节组最常累及的部位为跖趾关节(29例,67.4%),其次为膝关节(10例,23.2%)、踝关节(9例,20.9%), 此外还可见晶体沉积于腕关节(2例)、足背关节(2例)、近端指间关节(1例)。肌腱组最常累及的部位为股四头肌腱(16例,43.2%), 其次为跟腱(13例,35.1%)、髌腱(12例,32.4%)、肱三头肌腱(5例,13.5%),此外还可见晶体沉积于冈上肌腱(3例)、肩胛下肌腱(2例)、屈指肌腱(2例)、桡侧腕长伸肌腱(1例)、桡侧腕短伸肌腱(1例)、胫骨前肌腱(1例)、胫骨后肌腱(1例)、屈趾肌腱(1例)。3组间利用多样本方差分析/多样本秩和检验进行比较,患者年龄、尿酸初次升高年龄、血糖水平及C反应蛋白差异均有统计学意义;经多重比较,肌腱组年龄、尿酸初次升高年龄、C反应蛋白均显著高于无结晶组;无结晶组与关节组、肌腱组与关节组差异无统计学意义。结论:在痛风患者中,超声检测到晶体沉积于关节或肌腱是常见的,最常累及的部位包括跖趾关节、膝关节、踝关节,以及股四头肌肌腱、跟腱、髌腱、肱三头肌肌腱。3组间年龄、尿酸初次升高年龄、C反应蛋白、血糖水平差异有统计学意义,且有晶体沉积患者合并泌尿系结石的比例显著高于无结晶沉积者。

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

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.