Musculoskeletal ultrasonography identifies structural damage in chronic kidney disease patients with gouty arthritis
Zheng-Hao Huang1, Tony Szu-Hsien Lee2, Shu-Yi Lin3, Ya-Chi Li3, Fu-Chiang Yeh3, Chun-Chi Lu3
1 Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung; Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Department of Health Promotion and Health Education, National Taiwan Normal University, Taiwan
3 Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
No. 325, Sec. 2, Cheng-Gong Road, Neihu District, 114, Taipei
Source of Support: None, Conflict of Interest: None
Background: Renal insufficiency reduces the excretion of uric acid and inflammatory factors and exacerbates the structural deformities caused by gouty arthritis. Musculoskeletal ultrasonography (MSKUS) is often used to evaluate the severity and inflammatory progression of gout. Aim: We aimed to determine whether ultrasound help to identify structural damage in patients with chronic kidney disease (CKD) and gout. Methods: This was a retrospective review of the clinical manifestations and abnormalities observed with MSKUS in 280 patients with gouty arthritis between August 2004 and April 2017. MSKUS identified intra-articular features, including joint effusion, synovial proliferation, Baker's cysts, double contour sign, tophi, and extra-articular tenosynovitis. Serum and synovial fluid were collected and analyzed. Significant differences were identified using the Pearson correlation coefficient and independent t-test. Results: This retrospective cohort included 257 men (91.8%) and 23 women (8.2%) with a mean age of 54.6 years. CKD stage correlated positively with the presence of joint Baker's cyst (P = 0.004). Notably, serum estimated glomerular filtration rate correlated negatively with serum C-reactive protein level in patients with CKD (P < 0.001), and more severe CKD correlated with a higher prevalence of Baker's cyst in CKD patients (P = 0.0037). Conclusion: Insufficient control of hyperuricemia can lead to chronic gouty arthritis and subsequent structural deformities. Reciprocally, acute inflammation of joints is downregulated as chronic gouty arthritis develops. Patients with hyperuricemia and CKD should receive regular MSKUS examination to avoid the progression of structural damage in the joints.