To explore the feasibility of utlizing ultrasonography in evaluating the level of clinical pain in patients with gout in the first metatarsophalangeal joint.

From March 2022 to April 2023, the clinical and ultrasound data of 109 gout patients treated at the Gout Department of Affiliated Hospital of Qingdao University, were evaluated retrospectively. Patients were separated into 4 groups based on their pain intensity: no pain (n=25), mild pain (n=25), moderate pain (n=31), and severe pain (n=28). The ANOVA or Kruskal-Wallis H test was used to compare measurement data differences between groups. The Chi-square test or Fisher exact probability approach was used to examine differences in count data between groups. To compare rank data, the Kruskal-Wallis H test was utilized. Spearman correlation analysis was used to examine the relationship between pain level and ultrasonic characteristics. The Kappa consistency test and intra-class correlation coefficient (ICC) were used to assess the consistency of ultrasound image assessment among radiologists.

All 109 patients were male, with an average age of (44.62±14.91) years old. Among the 4 groups, clinical stage (χ²=76.31, P<0.01), number of tophus-positive cases (χ²=14.39, P<0.01), number of tophi (H=55.39, P<0.01), color Doppler (CD) signal in the synovium (H=15.49, P<0.01), CD signal in tophi (H=11.26, P<0.05) and total CD signal score (H=20.64, P<0.01) were statistically different. CD signal of the synovium (r=0.30, P<0.01), CD signal of the tophi(r=0.35, P<0.01), and the total CD signal score (r=0.43, P<0.01) were positively correlated with the pain intensity.

Gout patients′ pain can be accurately assessed using color Doppler ultrasound. Color Doppler signals in synovium and tophi are connected to patients′ pain level. Blood flow signal grading should be provided in ultrasonography reports to help with clinical staging and treatment decision-making.