Value of Semi-quantitative Scoring Based on Musculoskeletal Ultrasound in Diagnosis and Disease Assessment of Gouty Arthritis

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Methods Ninety patients with suspected GA who received in our hospital from January 2022 to December 2023 were retrospectively selected as the study objects. The puncture results of joint synovial fluid or crystal material in the joint cavity were used as the gold standard, and the patients 'joint effusion, synovitis, bone erosion and tenosynovitis were counted. Compare the musculoskeletal ultrasound semi-quantitative score with the puncture results of joint synovial fluid or crystal material in the joint cavity to diagnose different pathological types of GA, and evaluate the diagnostic efficiency of musculoskeletal ultrasound semi-quantitative score in diagnosing different pathological types of GA. Use correlation analysis to analyze the correlation between patients with the musculoskeletal ultrasound semi-quantitative score results, IL-6 and DAS28 scores, and typical musculoskeletal ultrasound and MRI examination results. Results There was no significant difference between the musculoskeletal ultrasound semi-quantitative score and the puncture results of joint synovial fluid or crystal material in the joint cavity. There was no significant difference between the examination results of different lesion types (P > 0.05). The puncture results of joint synovial fluid or crystal material in the joint cavity were used as the gold standard, the sensitivity of musculoskeletal ultrasound semi-quantitative scoring in diagnosing synovial thickening, joint effusion, bone erosion, and tendon/tendon sheath inflammation in GA patients was 92.86% (26/28), 96.00% (24/25), 95.24% (20/21), and 75.00% (12/16) respectively. The specificity values were 93.55% (58/62), 96.92% (63/65), 95.65% (66/69), and 98.65% (73/74) respectively. The accuracy rates were 93.33% (84/90), 96.67% (87/90), 95.56% (86/90), and 94.44% (85/90) respectively. According to Pearson linear correlation analysis, as the semi-quantitative scoring increased, there was a positive correlation with erythrocyte sedimentation rate, IL-6, and DAS28 scores (r = 0.729, 0.584, 0.773, P < 0.001). Observation of their serological indicators showed that there were significant differences in serological indicators between patients with different semi-quantitative scores ( P < 0.05). Conclusion Semi-quantitative scoring based on musculoskeletal ultrasound has high value in the diagnosis and assessment of gouty arthritis, and is worth further use. musculoskeletal ultrasound semi-quantitative scoring gouty arthritis disease assessment Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Gouty arthritis (GA), closely associated with hyperuricemia, is a metabolic joint disease. The core mechanism of its pathogenesis lies in the abnormal deposition of monosodium urate crystals in joints, tendons, and surrounding soft tissues, directly triggering an inflammatory reaction within the joint. This leads to intense pain, swelling, and functional impairment, significantly reducing the patients' quality of life [1] . With the rapid development of modern society, significant lifestyle changes, and increasingly diverse dietary habits, the incidence of gouty arthritis is showing an upward trend year by year. This situation urgently demands the medical community's heightened attention to early identification, accurate diagnosis, and comprehensive assessment of the disease [2-3] . In this context, musculoskeletal ultrasound, as an emerging non-invasive imaging technology, is gradually gaining recognition in the field of gouty arthritis diagnosis. Compared to traditional imaging methods like X-rays, CT scans, and MRIs, musculoskeletal ultrasound stands out due to its unique advantages like non-invasiveness, no radiation exposure, easy operation, cost-effectiveness, real-time imaging, and good repeatability, paving the way for a new approach to the diagnosis and evaluation of gouty arthritis [4-5] . Especially for patients sensitive to radiation or unsuitable for MRI examinations, musculoskeletal ultrasound becomes an ideal choice [6] . The semi-quantitative scoring system, through quantitative analysis of specific pathological features in such musculoskeletal ultrasound images as the volume of joint effusion, severity of synovitis [7] , extent of bone erosion, and presence and severity of tendon/tendon sheath inflammation, enables an objective assessment of the disease status [8-9] . This quantitative evaluation not only enhances the accuracy and reliability of diagnosis but also provides a scientific basis for dynamic monitoring of the disease, evaluation of treatment effectiveness, and prognosis prediction.The core of this study lies in further exploring the practical application value of the semi-quantitative scoring system based on musculoskeletal ultrasound in the diagnosis and disease assessment of GA. Research Objects and Methods 1.1 Research Objects 90 suspected gouty arthritis (GA) patients admitted to our hospital between January 2022 and December 2023 were retrospectively selected as the research subjects. The inclusion criteria were as follows: (1) Patients meeting the clinical diagnosis criteria for gouty arthritis[10]. (2) Age ≥ 18 years. (3) Patients with complete clinical data, including examination images and laboratory parameters (red blood cell sedimentation rate, IL-6) and DAS28 score.The exclusion criteria were as follows: (1) Patients with other bone and joint diseases. (2) Patients with mental disorders. (3) Patients with poor quality musculoskeletal ultrasound images. (4) Patients with severe immunological disorders. This experiment was approved by Zhengzhou Hospital of Traditional Chinese Medicine Ethics Committee.(No.V2023070403) 1.2 Research Methods With puncture results of synovial fluid or lens material in the joint cavity as the gold standard, among the 90 suspected patients,49 female patients, 41 male patients, age 32–62, average (42.64 ± 3.36),30 were diagnosed as GA patients. Within this group, 25 patients exhibited joint effusion, 28 patients showed synovitis, 21 patients had bone erosion, and 16 patients presented with tendon/tendon sheath inflammation. Musculoskeletal ultrasound semi-quantitative scoring:Inspect all joints Patients were examined in a seated position by a sonographer with over 3 years of experience in musculoskeletal ultrasound and familiarity with semi-quantitative scoring methods. Equipment preparation: The advanced TOSHIBA Aplio500 musculoskeletal ultrasound system, known for its high resolution and flexibility for various musculoskeletal structure examinations, was selected. Tailored selection of probe frequencies was made based on different joint sizes and locations. For larger or medium-sized joints like the ankle, shoulder, and knee, low-frequency probes covering the 4 to 13 MHz range were preferred to ensure clear imaging of deep tissues. For smaller structures like the proximal interphalangeal joints, high-frequency probes ranging from 7 to 16 MHz were used to enhance resolution and detail of superficial tissues. Patients were guided to adopt a comfortable and easily operable seated position to allow comprehensive assessment of key areas such as the anterior, lateral, and medial aspects of the joint. This positioning was particularly suitable for joint examinations requiring multi-directional observations such as the shoulder, knee, and elbow joints. The physician gently placed the selected frequency ultrasound probe on the joint area to be examined, ensuring good skin contact to minimize interference. Careful observation of the ultrasound images was conducted to capture joint structures, soft tissue status, and potential pathological changes. Pay special attention to whether there are typical ultrasound manifestations of gouty arthritis such as synovial thickening, effusion, or spot ultrasound in the tendon or periarticular synovial fluid in the joint cavity in the presence of Tophus or DCS.Combined with the characteristics of ultrasound images, we can comprehensively judge whether the patient suffers from gouty arthritis, and further evaluate the severity of the condition.Semi-quantitative scoring method [ 11 ] : ①Joint Effusion Score: 0 points, no effusion; 1 point, minimal effusion; 2 points, moderate effusion without joint capsule swelling; 3 points, large effusion with joint capsule swelling. ②Synovitis GSUS Score: 0 points, no synovial proliferation; 1 point, synovial proliferation below the highest line of the bone surface; 2 points, synovial proliferation extending outside the joint cavity but not involving the bone shaft; 3 points, synovial proliferation extending beyond the joint cavity, involving the bone shaft. ③Bone Erosion Score: 0 points, intact cortical bone; 1 point, irregular bone surface without defects in two planes; 2 points, rough surface with discontinuous cortical bone signal in two planes; 3 points, extensive bone destruction. ④Tendon/Tendon Sheath Inflammation Score: 0 points, no hyperechoic proliferation; 1 point, hypoechoic proliferation around the tendon. 1.3 Observation Indicators (1) Compare the semi-quantitative musculoskeletal ultrasound scoring with gold standard of different types of lesions in GA. (2) Evaluate the diagnostic efficacy of semi-quantitative musculoskeletal ultrasound scoring for different types of lesions in diagnosing GA. (3) Use correlation analysis to assess the correlation between semi-quantitative musculoskeletal ultrasound scoring results and erythrocyte sedimentation rate, IL-6, and DAS28 scores of patients. (4)Differences in serological indicators with different semi-quantitative scores.(5) Illustrative musculoskeletal ultrasound and MRI images of examination results. 1.4 Statistical Analysis The experimental data collected were analyzed with SPSS 27.0. Continuous data conforming to a normal distribution in the experimental data were expressed as X ± S. Independent sample t-tests were used for comparisons and Fisher test was used for comparisons among multiple groups. Count data were presented as frequencies or rates, and comparisons were made with χ2 test, Pearson was used to analyze the connection between variables.A statistical significance level was set at P < 0.05. Results 2.1 Comparison of Semi-quantitative Musculoskeletal Ultrasound Scoring with gold standard of Different Lesion Types in GA The comparison of semi-quantitative musculoskeletal ultrasound scoring with gold standard diagnosis of different lesion types in GA showed no statistically significant differences ( P > 0.05), as shown in Table 1 . Table 1 Comparison of Semi-quantitative Musculoskeletal Ultrasound Scoring with gold standard of Different Lesion Types in GA Examination Method Number of Cases Number of positive cases Synovial Thickening Number of positive cases Joint EffusionNumber of positive cases Bone Erosion Number of positive cases Tendonitis /Tenosynovitis Number of positive cases gold standard 90 28 25 21 16 Semi-quantitative Musculoskeletal Ultrasound Scoring 90 26 24 20 12 t/χ 2 Value 0.106 0.028 0.032 0.677 P Value 0.745 0.867 0.859 0.412 2.2 Diagnostic Efficiency of Semi-quantitative Musculoskeletal Ultrasound Scoring for Different Lesion Types in Diagnosing GA In 90 GA patients, with gold standard as the gold standard, focusing on individual joints,the sensitivity of semi-quantitative musculoskeletal ultrasound scoring in diagnosing synovial thickening, joint effusion, bone erosion, and tendonitis/tenosynovitis in GA patients was 92.86% (26/28), 96.00% (24/25), 95.24% (20/21), and 75.00% (12/16) respectively. The specificity was 93.55% (58/62), 96.92% (63/65), 95.65% (66/69), and 98.65% (73/74) respectively. The accuracy was 93.33% (84/90), 96.67% (87/90), 95.56% (86/90), and 94.44% (85/90) respectively. See Table 2 for details. Table 2 Diagnostic Efficiency of Semi-quantitative Musculoskeletal Ultrasound Scoring for Different Lesion Types in Diagnosing GA Method gold standard (Synovial Thickening) Total Method gold standard (Joint Effusion) Total Positive Negative Positive Negative Positive 26 4 30 Positive 24 2 26 Negative 2 58 60 Negative 1 63 64 Total 28 62 90 Total 25 65 90 Method gold standard (Bone Erosion) Total Method gold standard(Tendonitis/Tenosynovitis) Total Positive Negative Positive Negative Positive 20 3 23 Positive 12 1 13 Negative 1 66 67 Negative 4 73 77 Total 21 69 90 Total 16 74 90 2.3 Correlation of Semi-quantitative Musculoskeletal Ultrasound Scoring Results with Erythrocyte Sedimentation Rate, IL-6, and DAS28 Score in Patients Focus on the correlation between systemic inflammation indicators and DAS28 in each patient, and summarize the combined correlation in each case,According to the Pearson linear correlation analysis, with an increase in semi-quantitative scoring, the erythrocyte sedimentation rate, IL-6, and DAS28 score all increased, showing a positive correlation (r = 0.729, 0.584, 0.773, P < 0.001).See Table 3 for details. Table 3 Correlation Analysis Item Joint Effusion Score Synovitis GSUS Score Bone Erosion Score Tendon/tenosynovitis total score r P r P r P r P r P Erythrocyte Sedimentation Rate 0.616 < 0.001 0.548 < 0.001 0.573 < 0.001 0.298 0.004 0.729 < 0.001 IL-6 0.529 < 0.001 0.351 < 0.001 0.497 < 0.001 0.283 0.007 0.584 < 0.001 DAS28 0.676 < 0.001 0.624 < 0.001 0.549 < 0.001 0.284 0.007 0.773 < 0.001 2.4 Differences in serological indicators with different semi-quantitative scores Sum the scores for the four joint findings (synovial fluid thickening, effusion, bone erosion, and tendinitis/tendinitis), and then classify these totals by stage,Patients were divided into group 0, group 1–3, group 4–6, group 6, group ≥ 7, group 0, group 1–3, group 4–6, group 6, group ≥ 7. Observation of their serological indicators showed that there were significant differences in serological indicators between patients with different semi-quantitative scores ( P < 0.05), see Fig. 1 . 2.5 Typical Musculoskeletal Ultrasound and MRI Imaging Results MRI imaging results are renowned for their exceptional soft tissue resolution and spatial localization capabilities. These images are generated by exciting hydrogen protons within the body using a magnetic field and radiofrequency pulses, capturing the signals they release. MRI images are clear, detailed, and able to depict the structural characteristics of internal organs, tissues, and pathologies. A key difference between typical musculoskeletal ultrasound and MRI imaging results is that musculoskeletal ultrasound allows for real-time dynamic imaging, providing a visual display of the morphological changes in soft tissues such as muscles and bones during movement. This feature makes it particularly suitable for diagnosing motion-related disorders and impingement syndromes. Although the image quality of ultrasound is limited, it offers simplicity in operation, no radiation exposure, lower costs, strong doctor-patient interaction, and a comfortable examination process. Additionally, musculoskeletal ultrasound can simultaneously examine multiple joints, enhancing diagnostic efficiency. These advantages make musculoskeletal ultrasound the preferred imaging modality in specific scenarios.The examination results of some patients are shown in Figs. 3 to 6 Discussion This study aimed to explore the value of semi-quantitative scoring based on musculoskeletal ultrasound in the diagnosis and disease assessment of GA. By comparing it with gold standard, which is considered the gold standard, we conducted a detailed analysis of how musculoskeletal ultrasound performs in identifying different types of lesions in GA, such as joint effusion, synovitis, bone erosion, tendonitis/tenosynovitis [ 12 – 13 ] , and evaluated its diagnostic efficiency. Furthermore, we investigated the correlation between musculoskeletal ultrasound semi-quantitative scoring and clinical indicators in patients (such as erythrocyte sedimentation rate, IL-6 levels, DAS28 score) with the aim of providing more comprehensive and accurate information for the clinical management of GA [ 14 ] . Firstly, the results of this study indicate that there was no statistically significant difference in detection outcomes between musculoskeletal ultrasound and gold standard when diagnosing different types of lesions in GA (P > 0.05)(Table 1 ). This finding underscores the high accuracy of musculoskeletal ultrasound in the diagnosis of GA.Furthermore, the analysis of 90 patients further reinforces this conclusion. Specifically, musculoskeletal ultrasound semi-quantitative scoring excelled in diagnosing synovial thickening, joint effusion, bone erosion, tendonitis/tenosynovitis in GA patients, with high levels of sensitivity, specificity, and accuracy [ 15 ] . This result indicates that musculoskeletal ultrasound can accurately identify multiple types of lesions in GA and quantitatively assess the severity of these lesions, providing detailed and reliable diagnostic information for clinical use [ 16 – 17 ] . The reasons behind this include, firstly, the high resolution and real-time imaging capabilities of musculoskeletal ultrasound allow for clear visualization of subtle structural changes in and around the joints, enabling the accurate capture of GA's pathological features [ 18 – 19 ] . Secondly, the semi-quantitative scoring system of musculoskeletal ultrasound, through quantitative analysis of specific pathological features in ultrasound images, facilitates objective assessment of disease status, thereby enhancing diagnostic accuracy and repeatability [ 20 ] . Additionally, the advantages of musculoskeletal ultrasound, such as radiation-free imaging and cost-effectiveness, have promoted its widespread clinical application and in-depth research, providing robust support for the precise diagnosis of GA [ 21 ] . The semi-quantitative scoring system utilized in this study enabled a quantitative assessment of the extent of lesions in GA patients through detailed analysis of musculoskeletal ultrasound images. This quantitative assessment not only enhances the accuracy and objectivity of diagnosis but also provides the potential for dynamic monitoring of disease progression and evaluation of treatment efficacy [ 22 – 23 ] . In this study, with an increase in the semi-quantitative score, patients exhibited significant increases in erythrocyte sedimentation rate, IL-6 levels, and DAS28 score, showing a positive correlation(Table 3 , Fig. 1 ). This finding further validates the value of semi-quantitative scoring in assessing the severity of GA. Erythrocyte sedimentation rate, as one of the indicators reflecting the body's inflammatory response, tends to increase when there is active inflammation in GA patients [ 24 – 25 ] . L-6, as a crucial inflammatory cytokine, also plays a significant role in the development of GA. The DAS28 score serves as a comprehensive tool for assessing the activity of diseases like rheumatoid arthritis, but in this study, it was also used to evaluate the severity of GA [ 26 ] . The positive correlation between these clinical indicators and the semi-quantitative score indicates that the semi-quantitative scoring accurately reflects the inflammation levels and severity of the disease in GA patients, providing robust support for clinical decision-making [ 27 ] . OMERACT International has a shared definition of pathological ultrasound lesions in gout, covering a variety of lesions. However, not all these lesions were included in this scoring system because the number of cases was limited, some lesions were too small and lacked sensitivity, or were too correlated with clinical results, so they were excluded. After screening, the value of the semi-quantitative scoring based on musculoskeletal ultrasound in this study in the diagnosis and disease assessment of GA has also been fully verified. In the future, this scoring system is poised for broader applications. Firstly, the high sensitivity and resolution of musculoskeletal ultrasound enable the early detection of signs of lesions in GA, offering possibilities for early intervention and treatment of the disease. Regular monitoring of patients' musculoskeletal ultrasound images and evaluation using the semi-quantitative scoring system can facilitate timely detection of changes in the disease and adjustment of treatment plans. Secondly, the semi-quantitative scoring system can quantitatively assess the severity and progression trends of GA in patients, providing clinicians with more precise means of monitoring the disease [ 28 ] . By comparing scoring results at different time points, treatment effects can be evaluated, and disease outcomes predicted. During the course of treatment, musculoskeletal ultrasound semi-quantitative scoring can serve as a crucial indicator for assessing efficacy. By comparing changes in scores before and after treatment, treatment effects can be objectively evaluated, and treatment plans adjusted for optimal efficacy [ 29 ] . Moreover, the semi-quantitative scoring system based on musculoskeletal ultrasound can also provide a basis for personalized treatment for GA patients. By assessing specific conditions and characteristics of patients' illnesses, more targeted and personalized treatment plans can be devised to enhance treatment effectiveness and reduce adverse reactions [ 30 ] .Compared with other scoring systems, this scoring may focus more on individual assessment. By analyzing the patient's ultrasound images and specific conditions in detail, more targeted and personalized treatment plans can be formulated to improve treatment results and reduce adverse reactions. Compared with previous scoring systems, which may pay more attention to the integrity of joint structure, this scoring system may pay more attention to the deposition of urate crystals and the progression of lesions. In addition, this scoring system also analyzes the association with systemic inflammation indicators, aiming to serve as an aid and supplement to more comprehensively assess the patient's condition. While this study has achieved preliminary results, there are still some limitations to be acknowledged. Firstly, this study is retrospective in nature, with a relatively limited sample size that may introduce selection bias. Future research should focus on conducting larger-scale, multicenter prospective studies to further validate the findings of this study. Secondly, this study only explores the application value of musculoskeletal ultrasound in the diagnosis and assessment of GA and does not compare it with other imaging methods such as CT or PET-CT. Future research could delve into comparing the strengths and weaknesses of different imaging modalities in GA diagnosis and their complementary roles. Lastly, this study does not extensively investigate the relationship between musculoskeletal ultrasound semi-quantitative scoring and patient prognosis. Future studies could involve long-term follow-up research to assess the predictive value of semi-quantitative scoring for patient prognosis. In conclusion, the semi-quantitative scoring system based on musculoskeletal ultrasound holds significant application value in the diagnosis and assessment of GA. This scoring system enables the quantitative evaluation and dynamic monitoring of GA patients' conditions, providing robust support for clinical decision-making. With ongoing technological advancements and further researches, this scoring system is poised to play an even more crucial role in terms of the clinical management of GA in the future. Declarations Acknowledgment None Consent to Publish The manuscript has neither been previously published nor is under consideration by any other journal. The authors have all approved the content of the paper. Consent to participate We secured a signed informed consent form from every participant. Ethic Approval This experiment was approved by Zhengzhou Hospital of Traditional Chinese Medicine Ethics Committee.(No.V2023070403) Funding The special research topic of Traditional Chinese Medicine in Henan Province (Study on the curative effect and mechanism of Huashi-Jiangzhuoyin in the intervention of spleen deficiency and dampness-blocking gout patients based on the detection of channels and collagms).(No.2023ZY2146) Author Contribution [Panke Zhang]: Developed and planned the study, performed experiments, and interpreted results. Edited and refined the manuscript with a focus on critical intellectual contributions. [Dan Li]: Participated in collecting, assessing, and interpreting the date. Made significant contributions to date interpretation and manuscript preparation. [Dongyu Li]: Provided substantial intellectual input during the drafting and revision of the manuscript. Conflicts of Interest The authors declare that they have no financial conflicts of interest. References Anjum ZI, Bacha R, Manzoor I, Gilani SA. Reliability of knee joint sonography in the evaluation of gouty arthritis. Journal of ultrasonography. 2021;21(87):e300-e5. Badshah M, Nadeem I, Ahmed I, Naim T, Fanciullo J. Gout: A Rapid Review of Presentation, Diagnosis and Management. South Dakota medicine: the journal of the South Dakota State Medical Association. 2024;77(2):81–6. Bao H, Qi Y, Wei B, Ma B, Wang Y, Xu Y. Severe erosive lesion of the glenoid in gouty shoulder arthritis: a case report and review of the literature. BMC musculoskeletal disorders. 2021;22(1):343. Chen Y, Liu J, Li Y, Cong C, Hu Y, Zhang X, et al. 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Cite Share Download PDF Status: Published Journal Publication published 12 Feb, 2025 Read the published version in Clinical and Experimental Medicine → Version 1 posted Editorial decision: Revision requested 25 Nov, 2024 Reviews received at journal 25 Nov, 2024 Reviewers agreed at journal 25 Nov, 2024 Reviewers agreed at journal 24 Nov, 2024 Reviews received at journal 24 Nov, 2024 Reviewers agreed at journal 24 Nov, 2024 Reviewers agreed at journal 24 Nov, 2024 Reviewers invited by journal 24 Nov, 2024 Editor assigned by journal 12 Nov, 2024 Submission checks completed at journal 12 Nov, 2024 First submitted to journal 11 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5429748","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":382311785,"identity":"9443c555-830b-4d40-af4d-d8286f6d3cdc","order_by":0,"name":"Panke Zhang","email":"","orcid":"","institution":"Zhengzhou Hospital of Traditional Chinese Medicine，","correspondingAuthor":false,"prefix":"","firstName":"Panke","middleName":"","lastName":"Zhang","suffix":""},{"id":382311786,"identity":"544cc90c-765f-41cd-a706-e61b1d7a5617","order_by":1,"name":"Dan Li","email":"","orcid":"","institution":"Zhengzhou Hospital of Traditional Chinese Medicine，","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Li","suffix":""},{"id":382311787,"identity":"9002901b-c24e-422b-a641-81a9a24183a0","order_by":2,"name":"Dongyu Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBACewhlU8/Y3gNm8fAR0mLYAKbSEph7zjAwHABqYSOkxeAAmDqUwD4jB6yFgbCW472HX/O2Hcjjnfn24OOPOXYybAzMDx/dwKflzLk0a962O8WSs/OSDQ5uSwY6jM3YOAeflhs5Zsa8bc8YN87OMZM4uI0ZqIWHTZoILYcZ9988A9JST5QW48dALYmNM3hAWg4T1mLYc8aMcc65NGPGnhxjg7PbjvOwMRPwiz17j/GHN2U2coztZwwfVG6rtudnb374GJ8WIGCT4kHhM+NXDlby8QdhRaNgFIyCUTCSAQBLRUzWtA56awAAAABJRU5ErkJggg==","orcid":"","institution":"Zhengzhou Hospital of Traditional Chinese Medicine，","correspondingAuthor":true,"prefix":"","firstName":"Dongyu","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-11-11 07:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5429748/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5429748/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10238-025-01568-4","type":"published","date":"2025-02-12T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71693664,"identity":"6843e1b5-f13b-4a00-bf67-dc6077020643","added_by":"auto","created_at":"2024-12-17 18:52:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":117167,"visible":true,"origin":"","legend":"\u003cp\u003ePartial correlation diagram\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5429748/v1/9695bfe8df7af8bf840d9c80.jpeg"},{"id":71694006,"identity":"6640d59f-8ec6-42c6-a1da-41c0f3c66381","added_by":"auto","created_at":"2024-12-17 19:00:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":4458,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in serological indicators with different semi-quantitative scores\u003c/p\u003e\n\u003cp\u003eNOTE：Erythrocyte Sedimentation Rate(mm/h) ;IL-6 (pg/ml) ;DAS28 score (points)\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5429748/v1/b5fcd77527a2704f851e648c.png"},{"id":71694007,"identity":"cd9243c7-c6a7-4b73-b61a-101c0a8246f9","added_by":"auto","created_at":"2024-12-17 19:00:53","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":114428,"visible":true,"origin":"","legend":"\u003cp\u003eSynovitis of right metatarsophalangeal joint\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5429748/v1/73a1cda15d49a1ff667fb29e.jpeg"},{"id":71693666,"identity":"f2220afa-f435-4ce7-a0c5-49a4ab7eaa93","added_by":"auto","created_at":"2024-12-17 18:52:53","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":107083,"visible":true,"origin":"","legend":"\u003cp\u003eDCS of metatarsophalangeal joint of right foot\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5429748/v1/763c4b1b4eabe2804c641690.jpeg"},{"id":71693667,"identity":"605c7618-0875-4b3f-b107-2c3c4263c658","added_by":"auto","created_at":"2024-12-17 18:52:53","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":35621,"visible":true,"origin":"","legend":"\u003cp\u003eMRI coronal plane of right ankle t1\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-5429748/v1/6d0b8999c6228f43ea76f0b2.png"},{"id":71693669,"identity":"2a8140e6-6dc1-4989-a1f6-d01481571275","added_by":"auto","created_at":"2024-12-17 18:52:53","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":225730,"visible":true,"origin":"","legend":"\u003cp\u003eMagnetic resonance imaging of right ankle sagital plane t2\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5429748/v1/188a077737208fef5916835f.jpeg"},{"id":76487619,"identity":"8b9da57c-4680-41c2-a12c-8e2a41c32bca","added_by":"auto","created_at":"2025-02-17 16:10:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1655763,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5429748/v1/678d423b-e1b5-46c8-a66b-4a7e517651ea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Value of Semi-quantitative Scoring Based on Musculoskeletal Ultrasound in Diagnosis and Disease Assessment of Gouty Arthritis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGouty arthritis (GA), closely associated with hyperuricemia, is a metabolic joint disease. The core mechanism of its pathogenesis lies in the abnormal deposition of monosodium urate crystals in joints, tendons, and surrounding soft tissues, directly triggering an inflammatory reaction within the joint. This leads to intense pain, swelling, and functional impairment, significantly reducing the patients\u0026apos; quality of life \u003csup\u003e[1]\u003c/sup\u003e. With the rapid development of modern society, significant lifestyle changes, and increasingly diverse dietary habits, the incidence of gouty arthritis is showing an upward trend year by year. This situation urgently demands the medical community\u0026apos;s heightened attention to early identification, accurate diagnosis, and comprehensive assessment of the disease\u003csup\u003e[2-3]\u003c/sup\u003e. In this context, musculoskeletal ultrasound, as an emerging non-invasive imaging technology, is gradually gaining recognition in the field of gouty arthritis diagnosis. Compared to traditional imaging methods like X-rays, CT scans, and MRIs, musculoskeletal ultrasound stands out due to its unique advantages like non-invasiveness, no radiation exposure, easy operation, cost-effectiveness, real-time imaging, and good repeatability, paving the way for a new approach to the diagnosis and evaluation of gouty arthritis \u003csup\u003e[4-5]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEspecially for patients sensitive to radiation or unsuitable for MRI examinations, musculoskeletal ultrasound becomes an ideal choice\u003csup\u003e[6]\u003c/sup\u003e. The semi-quantitative scoring system, through quantitative analysis of specific pathological features in such musculoskeletal ultrasound images as the volume of joint effusion, severity of synovitis\u003csup\u003e[7]\u003c/sup\u003e, extent of bone erosion, and presence and severity of tendon/tendon sheath inflammation, enables an objective assessment of the disease status\u003csup\u003e[8-9]\u003c/sup\u003e. This quantitative evaluation not only enhances the accuracy and reliability of diagnosis but also provides a scientific basis for dynamic monitoring of the disease, evaluation of treatment effectiveness, and prognosis prediction.The core of this study lies in further exploring the practical application value of the semi-quantitative scoring system based on musculoskeletal ultrasound in the diagnosis and disease assessment of GA.\u003c/p\u003e"},{"header":"Research Objects and Methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Research Objects\u003c/h2\u003e \u003cp\u003e90 suspected gouty arthritis (GA) patients admitted to our hospital between January 2022 and December 2023 were retrospectively selected as the research subjects. The inclusion criteria were as follows: (1) Patients meeting the clinical diagnosis criteria for gouty arthritis[10]. (2) Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years. (3) Patients with complete clinical data, including examination images and laboratory parameters (red blood cell sedimentation rate, IL-6) and DAS28 score.The exclusion criteria were as follows: (1) Patients with other bone and joint diseases. (2) Patients with mental disorders. (3) Patients with poor quality musculoskeletal ultrasound images. (4) Patients with severe immunological disorders. This experiment was approved by Zhengzhou Hospital of Traditional Chinese Medicine Ethics Committee.(No.V2023070403)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Research Methods\u003c/h2\u003e \u003cp\u003eWith puncture results of synovial fluid or lens material in the joint cavity as the gold standard, among the 90 suspected patients,49 female patients, 41 male patients, age 32\u0026ndash;62, average (42.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36),30 were diagnosed as GA patients. Within this group, 25 patients exhibited joint effusion, 28 patients showed synovitis, 21 patients had bone erosion, and 16 patients presented with tendon/tendon sheath inflammation.\u003c/p\u003e \u003cp\u003eMusculoskeletal ultrasound semi-quantitative scoring:Inspect all joints Patients were examined in a seated position by a sonographer with over 3 years of experience in musculoskeletal ultrasound and familiarity with semi-quantitative scoring methods. Equipment preparation: The advanced TOSHIBA Aplio500 musculoskeletal ultrasound system, known for its high resolution and flexibility for various musculoskeletal structure examinations, was selected. Tailored selection of probe frequencies was made based on different joint sizes and locations. For larger or medium-sized joints like the ankle, shoulder, and knee, low-frequency probes covering the 4 to 13 MHz range were preferred to ensure clear imaging of deep tissues. For smaller structures like the proximal interphalangeal joints, high-frequency probes ranging from 7 to 16 MHz were used to enhance resolution and detail of superficial tissues. Patients were guided to adopt a comfortable and easily operable seated position to allow comprehensive assessment of key areas such as the anterior, lateral, and medial aspects of the joint. This positioning was particularly suitable for joint examinations requiring multi-directional observations such as the shoulder, knee, and elbow joints. The physician gently placed the selected frequency ultrasound probe on the joint area to be examined, ensuring good skin contact to minimize interference. Careful observation of the ultrasound images was conducted to capture joint structures, soft tissue status, and potential pathological changes. Pay special attention to whether there are typical ultrasound manifestations of gouty arthritis such as synovial thickening, effusion, or spot ultrasound in the tendon or periarticular synovial fluid in the joint cavity in the presence of Tophus or DCS.Combined with the characteristics of ultrasound images, we can comprehensively judge whether the patient suffers from gouty arthritis, and further evaluate the severity of the condition.Semi-quantitative scoring method\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e: ①Joint Effusion Score: 0 points, no effusion; 1 point, minimal effusion; 2 points, moderate effusion without joint capsule swelling; 3 points, large effusion with joint capsule swelling. ②Synovitis GSUS Score: 0 points, no synovial proliferation; 1 point, synovial proliferation below the highest line of the bone surface; 2 points, synovial proliferation extending outside the joint cavity but not involving the bone shaft; 3 points, synovial proliferation extending beyond the joint cavity, involving the bone shaft. ③Bone Erosion Score: 0 points, intact cortical bone; 1 point, irregular bone surface without defects in two planes; 2 points, rough surface with discontinuous cortical bone signal in two planes; 3 points, extensive bone destruction. ④Tendon/Tendon Sheath Inflammation Score: 0 points, no hyperechoic proliferation; 1 point, hypoechoic proliferation around the tendon.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Observation Indicators\u003c/h2\u003e \u003cp\u003e(1) Compare the semi-quantitative musculoskeletal ultrasound scoring with gold standard of different types of lesions in GA. (2) Evaluate the diagnostic efficacy of semi-quantitative musculoskeletal ultrasound scoring for different types of lesions in diagnosing GA. (3) Use correlation analysis to assess the correlation between semi-quantitative musculoskeletal ultrasound scoring results and erythrocyte sedimentation rate, IL-6, and DAS28 scores of patients. (4)Differences in serological indicators with different semi-quantitative scores.(5) Illustrative musculoskeletal ultrasound and MRI images of examination results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe experimental data collected were analyzed with SPSS 27.0. Continuous data conforming to a normal distribution in the experimental data were expressed as X\u0026thinsp;\u0026plusmn;\u0026thinsp;S. Independent sample t-tests were used for comparisons and Fisher test was used for comparisons among multiple groups. Count data were presented as frequencies or rates, and comparisons were made with χ2 test, Pearson was used to analyze the connection between variables.A statistical significance level was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Comparison of Semi-quantitative Musculoskeletal Ultrasound Scoring with gold standard of Different Lesion Types in GA\u003c/h2\u003e\n \u003cp\u003eThe comparison of semi-quantitative musculoskeletal ultrasound scoring with gold standard diagnosis of different lesion types in GA showed no statistically significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Semi-quantitative Musculoskeletal Ultrasound Scoring with gold standard of Different Lesion Types in GA\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExamination Method\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of Cases Number of positive cases\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSynovial Thickening Number of positive cases\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eJoint EffusionNumber of positive cases\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBone Erosion Number of positive cases\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTendonitis\u003c/p\u003e\n \u003cp\u003e/Tenosynovitis Number of positive cases\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003egold standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemi-quantitative Musculoskeletal Ultrasound Scoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et/\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Diagnostic Efficiency of Semi-quantitative Musculoskeletal Ultrasound Scoring for Different Lesion Types in Diagnosing GA\u003c/h2\u003e\n \u003cp\u003eIn 90 GA patients, with gold standard as the gold standard, focusing on individual joints,the sensitivity of semi-quantitative musculoskeletal ultrasound scoring in diagnosing synovial thickening, joint effusion, bone erosion, and tendonitis/tenosynovitis in GA patients was 92.86% (26/28), 96.00% (24/25), 95.24% (20/21), and 75.00% (12/16) respectively. The specificity was 93.55% (58/62), 96.92% (63/65), 95.65% (66/69), and 98.65% (73/74) respectively. The accuracy was 93.33% (84/90), 96.67% (87/90), 95.56% (86/90), and 94.44% (85/90) respectively. See Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e for details.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDiagnostic Efficiency of Semi-quantitative Musculoskeletal Ultrasound Scoring for Different Lesion Types in Diagnosing GA\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMethod\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003egold standard (Synovial Thickening)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMethod\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003egold standard (Joint Effusion)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMethod\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003egold standard (Bone Erosion)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMethod\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003egold standard(Tendonitis/Tenosynovitis)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.3 Correlation of Semi-quantitative Musculoskeletal Ultrasound Scoring Results with Erythrocyte Sedimentation Rate, IL-6, and DAS28 Score in Patients\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFocus on the correlation between systemic inflammation indicators and DAS28 in each patient, and summarize the combined correlation in each case,According to the Pearson linear correlation analysis, with an increase in semi-quantitative scoring, the erythrocyte sedimentation rate, IL-6, and DAS28 score all increased, showing a positive correlation (r\u0026thinsp;=\u0026thinsp;0.729, 0.584, 0.773, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).See Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e for details.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation Analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eJoint Effusion Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSynovitis GSUS Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBone Erosion Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTendon/tenosynovitis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003etotal score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eErythrocyte Sedimentation Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIL-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDAS28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e\u003cstrong\u003e2.4\u003c/strong\u003e Differences in serological indicators with different semi-quantitative scores\u003c/h2\u003e\n \u003cp\u003eSum the scores for the four joint findings (synovial fluid thickening, effusion, bone erosion, and tendinitis/tendinitis), and then classify these totals by stage,Patients were divided into group 0, group 1\u0026ndash;3, group 4\u0026ndash;6, group 6, group\u0026thinsp;\u0026ge;\u0026thinsp;7, group 0, group 1\u0026ndash;3, group 4\u0026ndash;6, group 6, group\u0026thinsp;\u0026ge;\u0026thinsp;7. Observation of their serological indicators showed that there were significant differences in serological indicators between patients with different semi-quantitative scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), see Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5 Typical Musculoskeletal Ultrasound and MRI Imaging Results\u003c/h2\u003e\n \u003cp\u003eMRI imaging results are renowned for their exceptional soft tissue resolution and spatial localization capabilities. These images are generated by exciting hydrogen protons within the body using a magnetic field and radiofrequency pulses, capturing the signals they release. MRI images are clear, detailed, and able to depict the structural characteristics of internal organs, tissues, and pathologies. A key difference between typical musculoskeletal ultrasound and MRI imaging results is that musculoskeletal ultrasound allows for real-time dynamic imaging, providing a visual display of the morphological changes in soft tissues such as muscles and bones during movement. This feature makes it particularly suitable for diagnosing motion-related disorders and impingement syndromes. Although the image quality of ultrasound is limited, it offers simplicity in operation, no radiation exposure, lower costs, strong doctor-patient interaction, and a comfortable examination process. Additionally, musculoskeletal ultrasound can simultaneously examine multiple joints, enhancing diagnostic efficiency. These advantages make musculoskeletal ultrasound the preferred imaging modality in specific scenarios.The examination results of some patients are shown in Figs. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e to \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore the value of semi-quantitative scoring based on musculoskeletal ultrasound in the diagnosis and disease assessment of GA. By comparing it with gold standard, which is considered the gold standard, we conducted a detailed analysis of how musculoskeletal ultrasound performs in identifying different types of lesions in GA, such as joint effusion, synovitis, bone erosion, tendonitis/tenosynovitis\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and evaluated its diagnostic efficiency. Furthermore, we investigated the correlation between musculoskeletal ultrasound semi-quantitative scoring and clinical indicators in patients (such as erythrocyte sedimentation rate, IL-6 levels, DAS28 score) with the aim of providing more comprehensive and accurate information for the clinical management of GA\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFirstly, the results of this study indicate that there was no statistically significant difference in detection outcomes between musculoskeletal ultrasound and gold standard when diagnosing different types of lesions in GA (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This finding underscores the high accuracy of musculoskeletal ultrasound in the diagnosis of GA.Furthermore, the analysis of 90 patients further reinforces this conclusion. Specifically, musculoskeletal ultrasound semi-quantitative scoring excelled in diagnosing synovial thickening, joint effusion, bone erosion, tendonitis/tenosynovitis in GA patients, with high levels of sensitivity, specificity, and accuracy\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. This result indicates that musculoskeletal ultrasound can accurately identify multiple types of lesions in GA and quantitatively assess the severity of these lesions, providing detailed and reliable diagnostic information for clinical use\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The reasons behind this include, firstly, the high resolution and real-time imaging capabilities of musculoskeletal ultrasound allow for clear visualization of subtle structural changes in and around the joints, enabling the accurate capture of GA's pathological features\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Secondly, the semi-quantitative scoring system of musculoskeletal ultrasound, through quantitative analysis of specific pathological features in ultrasound images, facilitates objective assessment of disease status, thereby enhancing diagnostic accuracy and repeatability \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Additionally, the advantages of musculoskeletal ultrasound, such as radiation-free imaging and cost-effectiveness, have promoted its widespread clinical application and in-depth research, providing robust support for the precise diagnosis of GA\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe semi-quantitative scoring system utilized in this study enabled a quantitative assessment of the extent of lesions in GA patients through detailed analysis of musculoskeletal ultrasound images. This quantitative assessment not only enhances the accuracy and objectivity of diagnosis but also provides the potential for dynamic monitoring of disease progression and evaluation of treatment efficacy\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. In this study, with an increase in the semi-quantitative score, patients exhibited significant increases in erythrocyte sedimentation rate, IL-6 levels, and DAS28 score, showing a positive correlation(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This finding further validates the value of semi-quantitative scoring in assessing the severity of GA. Erythrocyte sedimentation rate, as one of the indicators reflecting the body's inflammatory response, tends to increase when there is active inflammation in GA patients \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. L-6, as a crucial inflammatory cytokine, also plays a significant role in the development of GA. The DAS28 score serves as a comprehensive tool for assessing the activity of diseases like rheumatoid arthritis, but in this study, it was also used to evaluate the severity of GA\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The positive correlation between these clinical indicators and the semi-quantitative score indicates that the semi-quantitative scoring accurately reflects the inflammation levels and severity of the disease in GA patients, providing robust support for clinical decision-making\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOMERACT International has a shared definition of pathological ultrasound lesions in gout, covering a variety of lesions. However, not all these lesions were included in this scoring system because the number of cases was limited, some lesions were too small and lacked sensitivity, or were too correlated with clinical results, so they were excluded. After screening, the value of the semi-quantitative scoring based on musculoskeletal ultrasound in this study in the diagnosis and disease assessment of GA has also been fully verified. In the future, this scoring system is poised for broader applications. Firstly, the high sensitivity and resolution of musculoskeletal ultrasound enable the early detection of signs of lesions in GA, offering possibilities for early intervention and treatment of the disease. Regular monitoring of patients' musculoskeletal ultrasound images and evaluation using the semi-quantitative scoring system can facilitate timely detection of changes in the disease and adjustment of treatment plans. Secondly, the semi-quantitative scoring system can quantitatively assess the severity and progression trends of GA in patients, providing clinicians with more precise means of monitoring the disease \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. By comparing scoring results at different time points, treatment effects can be evaluated, and disease outcomes predicted. During the course of treatment, musculoskeletal ultrasound semi-quantitative scoring can serve as a crucial indicator for assessing efficacy. By comparing changes in scores before and after treatment, treatment effects can be objectively evaluated, and treatment plans adjusted for optimal efficacy\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Moreover, the semi-quantitative scoring system based on musculoskeletal ultrasound can also provide a basis for personalized treatment for GA patients. By assessing specific conditions and characteristics of patients' illnesses, more targeted and personalized treatment plans can be devised to enhance treatment effectiveness and reduce adverse reactions\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.Compared with other scoring systems, this scoring may focus more on individual assessment. By analyzing the patient's ultrasound images and specific conditions in detail, more targeted and personalized treatment plans can be formulated to improve treatment results and reduce adverse reactions. Compared with previous scoring systems, which may pay more attention to the integrity of joint structure, this scoring system may pay more attention to the deposition of urate crystals and the progression of lesions. In addition, this scoring system also analyzes the association with systemic inflammation indicators, aiming to serve as an aid and supplement to more comprehensively assess the patient's condition.\u003c/p\u003e \u003cp\u003eWhile this study has achieved preliminary results, there are still some limitations to be acknowledged. Firstly, this study is retrospective in nature, with a relatively limited sample size that may introduce selection bias. Future research should focus on conducting larger-scale, multicenter prospective studies to further validate the findings of this study. Secondly, this study only explores the application value of musculoskeletal ultrasound in the diagnosis and assessment of GA and does not compare it with other imaging methods such as CT or PET-CT. Future research could delve into comparing the strengths and weaknesses of different imaging modalities in GA diagnosis and their complementary roles. Lastly, this study does not extensively investigate the relationship between musculoskeletal ultrasound semi-quantitative scoring and patient prognosis. Future studies could involve long-term follow-up research to assess the predictive value of semi-quantitative scoring for patient prognosis.\u003c/p\u003e \u003cp\u003eIn conclusion, the semi-quantitative scoring system based on musculoskeletal ultrasound holds significant application value in the diagnosis and assessment of GA. This scoring system enables the quantitative evaluation and dynamic monitoring of GA patients' conditions, providing robust support for clinical decision-making. With ongoing technological advancements and further researches, this scoring system is poised to play an even more crucial role in terms of the clinical management of GA in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe manuscript has neither been previously published nor is under consideration by any other journal. The authors have all approved the content of the paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe secured a signed informed consent form from every participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthic Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis experiment was approved by Zhengzhou Hospital of Traditional Chinese Medicine Ethics Committee.(No.V2023070403)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe special research topic of Traditional Chinese Medicine in Henan Province (Study on the curative effect and mechanism of Huashi-Jiangzhuoyin in the intervention of spleen deficiency and dampness-blocking gout patients based on the detection of channels and collagms).(No.2023ZY2146)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[Panke Zhang]: Developed and planned the study, performed experiments, and interpreted results. Edited and refined the manuscript with a focus on critical intellectual contributions.\u003c/p\u003e\n\u003cp\u003e[Dan Li]: Participated in collecting, assessing, and interpreting the date. Made significant contributions to date interpretation and manuscript preparation.\u003c/p\u003e\n\u003cp\u003e[Dongyu Li]: Provided substantial intellectual input during the drafting and revision of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnjum ZI, Bacha R, Manzoor I, Gilani SA. Reliability of knee joint sonography in the evaluation of gouty arthritis. 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Deutsche medizinische Wochenschrift (1946). 2020;145(14):991\u0026ndash;1005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLafforgue A, Lambert C, Dubost JJ, Tournadre A, Soubrier M, Couderc M. Performance of a diagnostic score for gouty arthritis: results from a cohort of acute arthritis suspected of being septic. Rheumatology international. 2023;43(1):119\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee G, Cho FY, Goo B, Park YC. Acupuncture for gouty arthritis: A PRISMA-compliant protocol for a systematic review and meta-analysis of randomized controlled trials. Medicine. 2020;99(49):e23527.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu YR, Wang JQ, Li J. Role of NLRP3 in the pathogenesis and treatment of gout arthritis. Frontiers in immunology. 2023;14:1137822.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyu S, Ding R, Yang S, Chen W, Rao Y, OuYang H, et al. Establishment of a clinical diagnostic model for gouty arthritis based on the serum biochemical profile: A case-control study. Medicine. 2021;100(16):e25542.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMedina-Perez R, Baajour SA, Gonzalez S, Lopez JL, Campbell DJ. Septic Arthritis With Superimposed Acute Gouty Arthritis in a Rheumatoid Arthritis Patient. Cureus. 2022;14(4):e24352.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMika A, Gilbert W, Martin JR, Polkowski G. Diagnosis Dilemma, Culture-Negative Periprosthetic Hip Infection Versus Acute Gouty Arthritis: A Case Report. JBJS case connector. 2023;13(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiessink T, Giesen T, Efd\u0026eacute; M, Comarniceanu A, Janssen M, Otto C, et al. Test characteristics of Raman spectroscopy integrated with polarized light microscopy for the diagnosis of acute gouty arthritis. Joint bone spine. 2023;90(6):105611.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShao Q, Wang J. The Role of Ultrasound Semi-Quantitative Scoring in the Diagnosis and Assessment of Gout and Hyperuricemia. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine. 2024;43(2):281\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun Y, Wang L, Jr CG, Tian K. Gouty arthritis with acromioclavicular joint pain as the first predictor. Asian journal of surgery. 2023;46(12):5974\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Xu Y. Coexistence of Gouty and Septic Arthritis. Journal of clinical rheumatology: practical reports on rheumatic \u0026amp; musculoskeletal diseases. 2024;30(2):e67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu J, Yan J, Chang J, Li C, Xia B, Liu S, et al. Diagnostic values of different musculoskeletal ultrasound signs, serum uric acid, and their combined detection for gouty arthritis. Archives of rheumatology. 2024;39(2):265\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie Y, Li L, Luo R, Xu T, Yang L, Xu F, et al. Diagnostic efficacy of joint ultrasonography, dual-energy computed tomography and minimally invasive arthroscopy on knee gouty arthritis, a comparative study. The British journal of radiology. 2021;94(1121):20200493.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXue SW, Luo YK, Zhao YR, Jiao ZY. Musculoskeletal ultrasound in the Differential Diagnosis of Gouty Arthritis and Rheumatoid Arthritis. Pakistan journal of medical sciences. 2020;36(5):977\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYen YF, Lai YJ, Hsu LF, Chen LJ, Ku PW, Inan-Eroglu E. Association between vegetarian diet and gouty arthritis: A retrospective cohort study. Nutrition, metabolism, and cardiovascular diseases: NMCD. 2023;33(10):1923\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang B, Yang M, Wang H. Diagnostic value of ultrasound versus dual-energy computed tomography in patients with different stages of acute gouty arthritis. Clinical rheumatology. 2020;39(5):1649\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao D, Jin Z, Yu P, Li X, Yao J, Zhang W. Association between specific ultrasound features of joints and impaired kidney function among gout patients. Journal of clinical ultrasound: JCU. 2023;51(9):1553\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng W, Lu P, Jiang D, Chen L, Li Y, Deng H. An ultrasonographic study of gouty arthritis: Synovitis and its relationship to clinical symptoms: A retrospective analysis. Health science reports. 2023;6(6):e1312.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-and-experimental-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"clem","sideBox":"Learn more about [Clinical and Experimental Medicine](https://www.springer.com/journal/10238)","snPcode":"10238","submissionUrl":"https://submission.nature.com/new-submission/10238/3","title":"Clinical and Experimental Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"musculoskeletal ultrasound, semi-quantitative scoring, gouty arthritis, disease assessment","lastPublishedDoi":"10.21203/rs.3.rs-5429748/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5429748/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo explore value of semi-quantitative scoring based on musculoskeletal ultrasound in diagnosis and disease assessment of gouty arthritis (GA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNinety patients with suspected GA who received in our hospital from January 2022 to December 2023 were retrospectively selected as the study objects. The puncture results of joint synovial fluid or crystal material in the joint cavity were used as the gold standard, and the patients 'joint effusion, synovitis, bone erosion and tenosynovitis were counted. Compare the musculoskeletal ultrasound semi-quantitative score with the puncture results of joint synovial fluid or crystal material in the joint cavity to diagnose different pathological types of GA, and evaluate the diagnostic efficiency of musculoskeletal ultrasound semi-quantitative score in diagnosing different pathological types of GA. Use correlation analysis to analyze the correlation between patients with the musculoskeletal ultrasound semi-quantitative score results, IL-6 and DAS28 scores, and typical musculoskeletal ultrasound and MRI examination results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no significant difference between the musculoskeletal ultrasound semi-quantitative score and the puncture results of joint synovial fluid or crystal material in the joint cavity. There was no significant difference between the examination results of different lesion types (P \u0026gt; 0.05). The puncture results of joint synovial fluid or crystal material in the joint cavity were used as the gold standard, the sensitivity of musculoskeletal ultrasound semi-quantitative scoring in diagnosing synovial thickening, joint effusion, bone erosion, and tendon/tendon sheath inflammation in GA patients was 92.86% (26/28), 96.00% (24/25), 95.24% (20/21), and 75.00% (12/16) respectively. The specificity values were 93.55% (58/62), 96.92% (63/65), 95.65% (66/69), and 98.65% (73/74) respectively. The accuracy rates were 93.33% (84/90), 96.67% (87/90), 95.56% (86/90), and 94.44% (85/90) respectively. According to Pearson linear correlation analysis, as the semi-quantitative scoring increased, there was a positive correlation with erythrocyte sedimentation rate, IL-6, and DAS28 scores (r = 0.729, 0.584, 0.773, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Observation of their serological indicators showed that there were significant differences in serological indicators between patients with different semi-quantitative scores (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemi-quantitative scoring based on musculoskeletal ultrasound has high value in the diagnosis and assessment of gouty arthritis, and is worth further use.\u003c/p\u003e","manuscriptTitle":"Value of Semi-quantitative Scoring Based on Musculoskeletal Ultrasound in Diagnosis and Disease Assessment of Gouty Arthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 18:52:48","doi":"10.21203/rs.3.rs-5429748/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-25T11:51:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-25T07:13:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141616696763805143460403111829038603895","date":"2024-11-25T06:13:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311108580734112440661438550445798379540","date":"2024-11-24T18:54:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-24T16:20:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6412981232078203827295385663298202034","date":"2024-11-24T15:01:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324746043768737622190163790510171538428","date":"2024-11-24T09:36:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-24T09:16:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-12T07:35:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-12T07:32:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical and Experimental Medicine","date":"2024-11-11T07:29:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-and-experimental-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"clem","sideBox":"Learn more about [Clinical and Experimental Medicine](https://www.springer.com/journal/10238)","snPcode":"10238","submissionUrl":"https://submission.nature.com/new-submission/10238/3","title":"Clinical and Experimental Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d82c1e3a-f072-46aa-a8d8-6766bfd0e01a","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-17T16:04:51+00:00","versionOfRecord":{"articleIdentity":"rs-5429748","link":"https://doi.org/10.1007/s10238-025-01568-4","journal":{"identity":"clinical-and-experimental-medicine","isVorOnly":false,"title":"Clinical and Experimental Medicine"},"publishedOn":"2025-02-12 15:58:06","publishedOnDateReadable":"February 12th, 2025"},"versionCreatedAt":"2024-12-17 18:52:48","video":"","vorDoi":"10.1007/s10238-025-01568-4","vorDoiUrl":"https://doi.org/10.1007/s10238-025-01568-4","workflowStages":[]},"version":"v1","identity":"rs-5429748","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5429748","identity":"rs-5429748","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}