Schapira D, Stahl S, Izhak O B, Balbir-Gurman A, Nahir A M
Department of Rheumatology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Semin Arthritis Rheum. 1999 Aug;29(1):56-63. doi: 10.1016/s0049-0172(99)80038-9.
To analyze the factors which differentiate chronic tophaceous arthritis from rheumatoid arthritis.
We describe two cases of chronic gouty arthritis masquerading as rheumatoid arthritis. The characteristic features of each of these two conditions and the diagnostic approach are discussed in light of relevant literature.
The correct diagnosis was reached by the combination of accurate history taking (family history of gout, alcoholism, previous diuretic therapy and renal stones), guiding clinical features (subcutaneous tophaceous deposits) and specific radiological (assymetrical erosions with sclerotic margins and overlying edges) and laboratory findings (hyperuricemia and hyperuricosuria). It was confirmed by the identification of monosodium urate (MSU) crystals in the synovial and subcutaneous tissues.
Gout and rheumatoid arthritis rarely coexist. Chronic gouty arthritis may mimic rheumatoid arthritis, and vice-versa. Clinical suspicion supplemented by characteristic laboratory, radiological and histologic findings help at reaching an accurate diagnosis.
分析区分慢性痛风石性关节炎与类风湿关节炎的因素。
我们描述了两例伪装成类风湿关节炎的慢性痛风性关节炎病例。根据相关文献讨论了这两种疾病各自的特征及诊断方法。
通过准确的病史采集（痛风家族史、酗酒、既往利尿剂治疗及肾结石）、指导性临床特征（皮下痛风石沉积）、特定的影像学表现（边缘硬化及边缘覆盖的不对称侵蚀）以及实验室检查结果（高尿酸血症和高尿酸尿症）相结合得出正确诊断。通过在滑膜和皮下组织中鉴定出尿酸钠（MSU）晶体得以证实。
痛风和类风湿关节炎很少共存。慢性痛风性关节炎可能酷似类风湿关节炎，反之亦然。临床怀疑辅以特征性的实验室、影像学和组织学检查结果有助于做出准确诊断。
