medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-9-30-34medalphabet-3133Research ArticleСтатьиСонография как метод диагностики подагры на преклинической стадии (предварительные данные пилотного исследования)Sonography as method for diagnosing gout at preclinical stage (preliminary data from pilot study)https://orcid.org/0000-0002-4383-9872ЧеремушкинаЕ. В.CheremushkinaE. V.

Черемушкина Елена Владимировна, м.н.с. лаборатории микрокристаллических артритов

Москва

Cheremushkina Elena V., junior researcher at Laboratory of Microcrystalline Arthritis

Moscow

buipvybho@gmail.comЕлисеевМ. С.EliseevM. S.

Елисеев Максим Сергеевич, к. м. н., зав. лабораторией микрокристаллических артритов

Москва

Eliseev Maksim S., PhD Med, head of Laboratory of Microcrystalline Arthritis

Moscow

СевериноваМ. В.SeverinovaM. V.

Северинова Мария Викторовна, врач ультразвуковой диагностики отделения функциональной и ультразвуковой диагностики

Москва

Severinova Maria V., ultrasound diagnostics physician at Dept of Functional and Ultrasound Diagnostics

Moscow

https://orcid.org/0000-0002-5394-7869ЖелябинаО. В.ZhelyabinaO. V.

Желябина Ольга Владимировна, м. н. с. лаборатории микрокристаллических артритов

Москва

Zhelyabina Olga V., junior researcher at Laboratory of Microcrystalline Arthritis

Moscow

ФГБНУ «Научно-исследовательский институт ревматологии имени В. А. Насоновой»РоссияResearch Institute for Rheumatology n. a. V. A. NasonovaRussian Federation20232206202309Ревматология в общей врачебной практике (1)3034Copyright © Черемушкина Е.В., Елисеев М.С., Северинова М.В., Желябина О.В., 20232023Черемушкина Е.В., Елисеев М.С., Северинова М.В., Желябина О.В.Cheremushkina E.V., Eliseev M.S., Severinova M.V., Zhelyabina O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3133

Подагра является одним из наиболее распространенных ревматических заболеваний, особенность которого – развитие в условиях длительной гиперурикемии (ГУ). Стремительный рост заболеваемости подагрой при незначительном увеличении распространенности ГУ актуализирует вопрос диагностики подагры на доклинической стадии.

Цель исследования

Цель исследования. Определение частоты ультразвуковых признаков отложения кристаллов уратов у пациентов с асимптоматической ГУ (АГУ) и подагрой.

Результаты

Результаты. Включено 112 пациентом с АГУ и подагрой, средний возраст в обеих группах – 49,7 года. УЗИ-признаки депонирования кристаллов моноурата натрия (МУН) среди пациентов с АГУ определялись у 21,1% пациентов по УЗИ коленных суставов и 17,5% пациентов по УЗИ стоп. Пациенты с подагрой демонстрировали эти же УЗ-признаки в 38,1 и 56,3% случаев соответственно. Наблюдается сильная корреляция между выявлением МУН посредством УЗИ и анамнезом атаки артрита соответствующих суставов.

Выводы

Выводы. Обнаружение кристаллов МУН и сопутствующая ГУ являются весьма распространенными среди пациентов с АГУ, которую можно считать преклинической стадией подагры.

Gout is one of the most common rheumatic diseases, the peculiarity of which is the development in conditions of prolonged hyperuricemia (HU). The rapid increase in the incidence of gout with a slight increase in the prevalence of HU actualizes the issue of diagnosing gout at the preclinical stage.

Objective

Objective. To determine the frequency of ultrasound signs of urate crystal deposition in patients with asymptomatic HU (AHU) and gout.

Results

Results. 112 patients with AHU and gout were included, the mean age in both groups was 49.7 years. Ultrasound signs of deposition of sodium monourate crystals (SMC) among patients with AHU were determined in 21.1% of the patient by ultrasound of the knee joints and 17.5% of patients by ultrasound of the feet. Patients with gout showed the same US features in 38.1% and 56.3% of cases, respectively. There is a strong correlation between the detection of SMC by ultrasound and a history of arthritis attack of the respective joints.

Conclusions

Conclusions. The detection of SMC and concomitant HU is very common among patients with AHU, which can be considered the preclinical stage of gout.

моноурат натриягиперурикемияподаграультразвуковое исследованиеsodium monouratehyperuricemiagoutultrasoundРабота выполнена в рамках фундаментальной научной темы «Разработка междисциплинарной персонализированной модели оказания помощи пациентам с аутовоспалительными дегенеративными заболеваниями» № 1021051403074–2.The work was carried out within the framework of the fundamental scientific theme ‘Development of an interdisciplinary personalized model of care for patients with autoinflammatory degenerative diseases’ No. 1021051403074–2.ReferencesGBD2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10; 392 (10159): 1859–1922. DOI: 10.1016/S0140–6736(18)32335–3.GBD2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10; 392 (10159): 1859–1922. DOI: 10.1016/S0140–6736(18)32335–3.Dalbeth N, Phipps-Green A, Frampton C, Neogi T, Taylor WJ, Merriman TR. Relationship between serum urate concentration and clinically evident incident gout: an individual participant data analysis. Ann Rheum Dis. 2018 Jul; 77 (7): 1048–1052. DOI: 10.1136/annrheumdis-2017–212288.Dalbeth N, Phipps-Green A, Frampton C, Neogi T, Taylor WJ, Merriman TR. Relationship between serum urate concentration and clinically evident incident gout: an individual participant data analysis. Ann Rheum Dis. 2018 Jul; 77 (7): 1048–1052. DOI: 10.1136/annrheumdis-2017–212288.Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011 Oct; 63 (10): 3136–41. DOI: 10.1002/art.30520.Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011 Oct; 63 (10): 3136–41. DOI: 10.1002/art.30520.Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol. 2014 Mar; 26 (2): 186–91. DOI: 10.1097/BOR.0000000000000028.Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol. 2014 Mar; 26 (2): 186–91. DOI: 10.1097/BOR.0000000000000028.Dalbeth N, Stamp L. Hyperuricaemia and gout: time for a new staging system? Ann Rheum Dis. 2014 Sep; 73 (9): 1598–600. DOI: 10.1136/annrheumdis-2014–205304.Dalbeth N, Stamp L. Hyperuricaemia and gout: time for a new staging system? Ann Rheum Dis. 2014 Sep; 73 (9): 1598–600. DOI: 10.1136/annrheumdis-2014–205304.Dalbeth N, Schumacher HR, Fransen J, et al. Survey Definitions of Gout for Epidemiologic Studies: Comparison with Crystal Identification as the Gold Standard. Arthritis Care Res (Hoboken). 2016 Dec; 68 (12): 1894–1898. DOI: 10.1002/acr.22896.Dalbeth N, Schumacher HR, Fransen J, et al. Survey Definitions of Gout for Epidemiologic Studies: Comparison with Crystal Identification as the Gold Standard. Arthritis Care Res (Hoboken). 2016 Dec; 68 (12): 1894–1898. DOI: 10.1002/acr.22896.Елисеев МС. Классификационные критерии подагры (рекомендации ACR/EULAR). Научно-практическая ревматология. 2015; 53(6): 581–5. http://dx.doi.org/10.14412/1995–4484–2015–581–585.Eliseev M.S. Gout classification criteria (ACR/EULAR guidelines). Rheumatology Science and Practice. 2015; 53 (6): 581–585. (In Russ.) DOI: http://dx.doi.org/10.14412/1995–4484–2015–581–585.Espejo D, Dearing E, Ogle K Y, et al. (May 18, 2021) Images in Primary Care Medicine: Point-of-Care Ultrasound in Gout. Cureus 13(5): e15096. DOI: 10.7759/cureus.15096.Espejo D, Dearing E, Ogle K Y, et al. (May 18, 2021) Images in Primary Care Medicine: Point-of-Care Ultrasound in Gout. Cureus 13(5): e15096. DOI: 10.7759/cureus.15096.Keen HI, Davis WA, Latkovic E, Drinkwater JJ, Nossent J, Davis TME. Ultrasonographic assessment of joint pathology in type 2 diabetes and hyperuricemia: The Fremantle Diabetes Study Phase II. J Diabetes Complications. 2018 Apr; 32 (4): 400–405. DOI: 10.1016/j.jdiacomp.2017.12.015.Keen HI, Davis WA, Latkovic E, Drinkwater JJ, Nossent J, Davis TME. Ultrasonographic assessment of joint pathology in type 2 diabetes and hyperuricemia: The Fremantle Diabetes Study Phase II. J Diabetes Complications. 2018 Apr; 32 (4): 400–405. DOI: 10.1016/j.jdiacomp.2017.12.015.Rui L, Cheng H, Di W, Xinghai Xia, Jianqiu G, Haixia G, Zhongyan S, Weiping T. Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis. BioMed Research International. 2015. 1–12. DOI: 10.1155/2015/762820.Rui L, Cheng H, Di W, Xinghai Xia, Jianqiu G, Haixia G, Zhongyan S, Weiping T. Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis. BioMed Research International. 2015. 1–12. DOI: 10.1155/2015/762820.Cao L, Zhao T, Xie C, Zheng S, Wan W, Zou H, Zhu X. Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia. J Immunol Res. 2021 Apr 5; 2021: 5550626. DOI: 10.1155/2021/5550626.Cao L, Zhao T, Xie C, Zheng S, Wan W, Zou H, Zhu X. Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia. J Immunol Res. 2021 Apr 5; 2021: 5550626. DOI: 10.1155/2021/5550626.Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford). 2007 Jul; 46 (7): 1116–21. DOI: 10.1093/rheumatology/kem058. Epub 2007 Apr 27. PMID: 17468505.Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford). 2007 Jul; 46 (7): 1116–21. DOI: 10.1093/rheumatology/kem058. Epub 2007 Apr 27. PMID: 17468505.Черемушкина Е.В., Елисеев М.С. Гиперурикемия и подагра: влияние на костный метаболизм и суставной хрящ (обзор литературы). Ожирение и метаболизм. 2022; 19 (3): 348–357. https://doi.org/10.14341/omet12894Cheremushkina EV, Eliseev MS Hyperuricemia and gout: effects on bone and articular cartilage (literature review). Obesity and metabolism. 2022; 19 (3): 348–357. (In Russ.) https://doi.org/10.14341/omet12894Желябина О.В., Елисеев М.С. Ингибиторы ксантиноксидазы при асимптоматической гиперурикемии. Современная ревматология. 2019. Т. 13. № 4. С. 137–114. DOI: https://doi.org/10.14412/1996–7012–2019–4–137–142.Zhelyabina OV, Eliseev MS. Xanthine oxidase inhibitors in asymptomatic hyperuricemia. Modern Rheumatology Journal. 2019; 13 (4): 137–142. (In Russ.) DOI: https://doi.org/10.14412/1996–7012–2019–4–137–142.Dalbeth N, House ME, Aati O, et al. Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis. 2015; 74 (5): 908–911. DOI: https://doi.org/10.1136/annrheumdis-2014–20639.Dalbeth N, House ME, Aati O, et al. Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis. 2015; 74 (5): 908–911. DOI: https://doi.org/10.1136/annrheumdis-2014–20639.Chhana A, Pool B, Wei Y, et al. Human Cartilage Homogenates Influence the Crystallization of Monosodium Urate and Inflammatory Response to Monosodium Urate Crystals: A Potential Link Between Osteoarthritis and Gout. Arthritis Rheumatol. 2019; 71 (12): 2090–2099. DOI: https://doi.org/10.1002/art.41038.Chhana A, Pool B, Wei Y, et al. Human Cartilage Homogenates Influence the Crystallization of Monosodium Urate and Inflammatory Response to Monosodium Urate Crystals: A Potential Link Between Osteoarthritis and Gout. Arthritis Rheumatol. 2019; 71 (12): 2090–2099. DOI: https://doi.org/10.1002/art.41038.Pattamapaspong N, Vuthiwong W, Kanthawang T, Louthrenoo W. Value of ultrasonography in the diagnosis of gout in patients presenting with acute arthritis. Skeletal Radiol. 2017 Jun; 46 (6): 759–767. DOI: 10.1007/s00256–017–2611-z. Epub 2017 Mar 8. PMID: 28275814.Pattamapaspong N, Vuthiwong W, Kanthawang T, Louthrenoo W. Value of ultrasonography in the diagnosis of gout in patients presenting with acute arthritis. Skeletal Radiol. 2017 Jun; 46 (6): 759–767. DOI: 10.1007/s00256–017–2611-z. Epub 2017 Mar 8. PMID: 28275814.Fenando A, Rednam M, Gujarathi R, Widrich J. Gout. 2022 May 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 31536213.Fenando A, Rednam M, Gujarathi R, Widrich J. Gout. 2022 May 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 31536213.Stewart S, Dalbeth N, Vandal AC, Rome K. The first metatarsophalangeal joint in gout: A systematic review and meta-analysis. BMC Musculoskelet Disord. 2016 Feb 11; 17: 69. DOI: 10.1186/s12891–016–0919–9. PMID: 26864742; PMCID: PMC4750194.Stewart S, Dalbeth N, Vandal AC, Rome K. The first metatarsophalangeal joint in gout: A systematic review and meta-analysis. BMC Musculoskelet Disord. 2016 Feb 11; 17: 69. DOI: 10.1186/s12891–016–0919–9. PMID: 26864742; PMCID: PMC4750194.Lee SJ, Nam KI, Jin HM, Cho YN, Lee SE, Kim TJ, Lee SS, Kee SJ, Lee KB, Kim N, Park YW. Bone destruction by receptor activator of nuclear factor κB ligand-expressing T cells in chronic gouty arthritis. Arthritis Res Ther. 2011; 13 (5): R164. DOI: 10.1186/ar3483. Epub 2011 Oct 13. PMID: 21992185; PMCID: PMC3308097.Lee SJ, Nam KI, Jin HM, Cho YN, Lee SE, Kim TJ, Lee SS, Kee SJ, Lee KB, Kim N, Park YW. Bone destruction by receptor activator of nuclear factor κB ligand-expressing T cells in chronic gouty arthritis. Arthritis Res Ther. 2011; 13 (5): R164. DOI: 10.1186/ar3483. Epub 2011 Oct 13. PMID: 21992185; PMCID: PMC3308097.Terkeltaub RA. Clinical practice. Gout. N Engl J Med. 2003 Oct 23; 349 (17): 1647–55. DOI: 10.1056/NEJMcp030733. PMID: 14573737.Terkeltaub RA. Clinical practice. Gout. N Engl J Med. 2003 Oct 23; 349 (17): 1647–55. DOI: 10.1056/NEJMcp030733. PMID: 14573737.Schlesinger N, Thiele RG. The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis. 2010 Nov; 69 (11): 1907–12. DOI: 10.1136/ard.2010.128454. Epub 2010 Aug 12. PMID: 20705636.Schlesinger N, Thiele RG. The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis. 2010 Nov; 69 (11): 1907–12. DOI: 10.1136/ard.2010.128454. Epub 2010 Aug 12. PMID: 20705636.Zhang Y, Dong XZ, Yuan HS. Study on the deposition of monosodium urate in patients with first-episode of acute gouty arthritis by dual energy CT. Zhonghua Yi Xue Za Zhi. 2020 Aug 18; 100 (31): 2441–2445. Chinese. DOI: 10.3760/cma.j.cn112137–20200325–00925. PMID: 32819060.Zhang Y, Dong XZ, Yuan HS. Study on the deposition of monosodium urate in patients with first-episode of acute gouty arthritis by dual energy CT. Zhonghua Yi Xue Za Zhi. 2020 Aug 18; 100 (31): 2441–2445. Chinese. DOI: 10.3760/cma.j.cn112137–20200325–00925. PMID: 32819060.

The authors declare that there are no conflicts of interest present.