Integrating Musculoskeletal Ultrasound and Serological Markers to Optimize Acute Gouty Arthritis Diagnosis

OBJECTIVE: This study aimed to evaluate the diagnostic utility of combining musculoskeletal ultrasound (MSUS) with serum levels of hypoxia-inducible factor-1α (HIF-1α) and cyclooxygenase-2 (COX-2) for acute gouty arthritis (AGA). METHODS: The study included 122 patients hospitalized for gouty arthritis between February 2021 and February 2022. Of these, 60 patients presented with AGA, while 62 had non-acute gouty arthritis (NAGA). Semi-quantitative musculoskeletal ultrasound (MSUS) scores and serum levels of hypoxia-inducible factor-1α (HIF-1α) and cyclooxygenase-2 (COX-2) were compared between the two groups. A Disease Activity Score-28 (DAS28) was used to further classify the AGA group into low-activity and high-activity subgroups. RESULTS: MSUS scores, DAS28, and serum levels of HIF-1α and COX-2 were significantly elevated in the AGA group compared to the NAGA group (p < 0.05). Furthermore, within the AGA group, the high-activity subgroup exhibited higher MSUS semi-quantitative scores, DAS28 scores, and serum levels of HIF-1α and COX-2 compared to the low-activity subgroup (p < 0.05). Pearson correlation analysis revealed a positive correlation between the MSUS semi-quantitative score and serum levels of HIF-1α, COX-2, as well as the DAS28 score in patients diagnosed with AGA (p < 0.05). The combined application of MSUS semi-quantitative scoring and serological markers provided significantly enhanced diagnostic accuracy for AGA and better assessment of disease activity compared to any individual marker. CONCLUSIONS: MSUS and serum HIF-1α and COX-2 represent valuable tools for assessing the acute phase and disease activity of AGA. The combined diagnostic approach demonstrates superior effectiveness and holds potential for broader clinical application.