Ultrasound Evaluation of Three Outcome Domains in the Follow-up of Urate-Lowering Therapy in Gout: An Observational Study.

Abstract

This prospective study was aimed at observing the changes in three ultrasound (US) outcome domains (urate deposition, joint inflammation and bone erosion) in gout patients within the 1 y on urate-lowering therapy. The elementary lesions, including tophus, double-contour (DC) sign, aggregates, synovitis and bone erosion of the bilateral knee, ankle and first metatarsophalangeal joints, were evaluated repeatedly by US before and after 3, 6 and 12 mo of treatment, and the effective rates of clearance of tophus, DC sign and aggregates in different time groups were compared. A Global OMERACT-EULAR Synovitis Score (GLOESS) was calculated for these three paired joints to observe the inflammation. Bone erosion was also scored. The correlation between serum uric acid levels and tophus size changes was analyzed. Our results indicated that the decrease in serum uric acid levels was not completely parallel to the decrease in tophus size. For tophus, there was no significant difference in the clearance rate between different time groups (χ2\u202f=\u202f1.76, p\u202f=\u202f0.392), while for DC sign and aggregates, there were significant differences (χ2\u202f=\u202f21.48, p < 0.001, χ2\u202f=\u202f7.75, p\u202f=\u202f0.018). Meanwhile, GLOESS was significantly lower after 6 mo of therapy (χ2\u202f=\u202f32.316, p < 0.001). Additionally, bone erosion had not improved after 1 y of treatment (Z\u202f=\u202f-1.633, p\u202f=\u202f0.102). Thus, US is crucial for assessing response to urate-lowering therapy in gout.