Comparison of bone destruction markers in patients with gouty arthritis under different musculoskeletal ultrasonic manifestations

Objectives To observe the correlation between the different ultrasonic manifestations of gouty arthritis and the indexes of bone destruction (Dickkopf-1, RANKL), in order to further explore the role of musculoskeletal ultrasonography in the diagnosis and monitoring of gouty arthritis. Methods 160 cases of gouty arthritis from clinic of the Department of Rheumatology of Peking University People′s Hospital between July 2016 and June 2017 were recruited in this study. These patients were examined by musculoskeletal ultrasonography (bilateral first metatarsophalangeal joints, bilateral ankle joints and bilateral knee joints). Grouping was based on ultrasound features of joints. Group A showed no aggregate .Group B showed aggregate and double contour signs. Group C showed tophus and bone erosion. Serum concentrations of Dickkopf-1 and RANKL were measured. The correlations of Dickkopf-1 or RANKL and clinical/laboratory parameters were analyzed. Results (1)There was a significant difference in Dickkopf-1 concentration between the three groups(P<0.001). And the group C[(1 722.2±482.7)ng/L]was higher than the group B[(1 309.3±496.4)ng/L](t=4.418, P<0.001), and the group B was higher than group A[(807.9±373.8)ng/L](t=6.137, P<0.001). (2)There was a significant difference in RANKL concentration between the three groups (P<0.001). And the group C[(0.78±0.47)ng/L]was higher than the group B[(0.35±0.29)ng/L](t=5.456, P<0.001), and the group B was higher than group A[(0.10±0.09)ng/L](t=6.923, P<0.001). (3)The level of Dickkopf-1 was associated with the disease duration(r=0.430, P<0.001), and the level of RANKL was associated with the disease duration(r=0.359, P<0.001). Conclusion Aggregates, double contour signs, tophus and bone erosion can be observed in the ultrasonic examination of gouty arthritis. And the longer the duration of the disease, the more likely the extent of bone destruction is. Joint ultrasound can be the first imaging examination for the extent of joint involvement in gouty arthritis. And the longer the duration of the disease, the more likely the extent of bone destruction is. Musculoskeletal ultrasonography can be the preferred imaging method for detecting the extent of joint involvement in gouty arthritis. Key words: Arthritis, gouty; Ultrasonography; Intercellular signaling peptides and proteins; RANK ligand