Application of a Novel Ultrasound Scoring System in Assessing Disease Activity in Gouty Arthritis

To analyze the application value of a novel ultrasound scoring system in evaluating disease activity in patients with gouty arthritis (GA).

A total of 150 GA patients were enrolled. After excluding 2 patients with DAS28 < 2.6 (remission) due to insufficient sample size for statistical analysis, the remaining 148 patients were divided into a low-activity group (DAS28 2.6-3.2, n = 39) and a moderate-to-high activity group (DAS28 > 3.2, n = 111) based on the 28-joint Disease Activity Score (DAS28). Under musculoskeletal ultrasound (MSUS), joint lesions in both groups were observed, and ultrasonographic signs were scored. Differences in ultrasound scores, serum uric acid (SUA), erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (CRP) between the two groups were compared. The correlations between the total ultrasound score and DAS28, disease duration, SUA, ESR, and CRP were analyzed. Additionally, a receiver operating characteristic (ROC) curve was constructed, and the area under the curve (AUC) was calculated to evaluate the diagnostic value of the total ultrasound score for GA disease activity.

The double contour sign score, hyperechoic aggregates score, hyperechoic spot score, joint effusion score, synovial hyperplasia score, bone erosion score, and total ultrasound score were significantly higher in the moderate-to-high activity group than in the low-activity group (all P < 0.05). Similarly, ESR and CRP levels were also elevated in the moderate-to-high activity group (all P < 0.05). Correlation analysis indicated that the total ultrasound score was positively correlated with DAS28, disease duration, ESR, and CRP (r = 0.473, 0.317, 0.318, and 0.246, respectively; all P < 0.05) but showed no significant correlation with SUA level (r = -0.025, P > 0.05). Furthermore, the total musculoskeletal ultrasound score demonstrated an AUC of 0.714 (95% CI: 0.627-0.800) for differentiating GA disease activity, with a sensitivity of 64.0% and a specificity of 82.1%. For comparison, ESR yielded an AUC of 0.871 (95% CI: 0.810-0.932) with a sensitivity of 80.2% and specificity of 79.5%, while hs-CRP yielded an AUC of 0.846 (95% CI: 0.776-0.916) with a sensitivity of 77.5% and specificity of 82.1%. The AUC of the ultrasound score was lower than that of ESR (P = 0.008) and hs-CRP (P = 0.023), but its specificity was comparable.

The novel ultrasound scoring system may serve as a useful adjunctive tool for assessing disease activity in GA, demonstrating moderate diagnostic value. Further prospective studies are needed to validate its clinical utility and applicability.