Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout
Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout
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DOI：
10.1136/ard.2006.060368
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发表时间：
2007-08-01
影响因子：
27.4
通讯作者：
Sivera, Francisca
中科院分区：
文献类型：
--
作者：
Pascual, Eliseo;Sivera, Francisca
目的：确定低尿酸血症治疗是否导致痛风关节尿酸盐结晶消失，并确定治疗所需的时间。方法：18例痛风患者，在降低血尿酸(SUA)治疗成功后，每3个月对无症状的信号关节(11个膝关节，7个第一跖趾关节)进行关节穿刺术，以获取滑液样本。然后对样品进行了MSU晶体的存在分析，并记录了晶体数量/400x场。结果：所有18个关节在血尿酸降至正常水平后，关节滑液中MSU晶体消失。痛风消失时间为3~33个月，消失时间与痛风持续时间呈正相关(r(S)=0.71；p<；0.01)。降低尿酸前SF样品中MSU晶体的中位数为7.5(2.5-11)个/400x场，3个月后减少到3(1-6.5)个/400x场(p<；0.05)。结论：痛风患者血尿酸降至正常水平，尿酸结晶消失，病程长的痛风患者尿酸盐结晶消失时间较长。这表明尿酸盐晶体在关节中的沉积是可逆的。血尿酸水平的正常化导致无症状痛风关节SF中MSU晶体浓度的降低。这可能部分解释了当患者接受降低尿酸的药物治疗时痛风发作频率降低的原因。
Objectives: To determine whether hypouricaemic treatment results in the disappearance of urate crystals from gouty joints and to define the time required.Methods: In 18 patients with monosodium urate (MSU) crystal proven gout, and after the initiation of successful serum uric acid (SUA)- lowering treatment, an arthrocentesis of the asymptomatic signal joint ( 11 knees, 7 first metatarsophalangeal joints) was performed every 3 months to obtain a synovial fluid (SF) sample. The sample was then analysed for the presence of MSU crystals, and the number of crystals/400x field was noted. SUA levels and the duration of gout were also noted.Results: MSU crystals disappeared from the SF of all 18 joints after reduction of SUA to normal levels. The time required for disappearance ranged from 3 to 33 months; disappearance time correlated with the duration of gout (r(s) = 0.71; p < 0.01). The median number of MSU crystals in the SF samples before urate-lowering treatment was 7.5 (2.5-11) crystals/400x field, reducing to 3 (1-6.5) crystals/400x field (p < 0.05) at 3 months. Crystal counts continued to decrease after 3 months.Conclusions: In gout, reduction of SUA to normal levels results in disappearance of urate crystals from SF, requiring a longer time in those patients with gout of longer duration. This indicates that urate crystal deposition in joints is reversible. Normalisation of SUA levels results in a decrease in the concentration of MSU crystals in SF in the asymptomatic gouty joints. This may partially explain the reduced frequency of gouty attacks when a patient has been treated with SUA-lowering drugs.