Bajaj S, Fessler B J, Alarcón G S
Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA.
Rheumatology (Oxford). 2004 Mar;43(3):349-52. doi: 10.1093/rheumatology/keh043. Epub 2004 Jan 6.
To examine the frequency of gouty arthritis in patients with systemic lupus erythematosus (SLE) and elucidate the clinical factors that predispose to this occurrence.
A chart review of in-patients (1989-2001) and out-patients (1999-2001) with ICD9 billing codes for gouty arthritis/tophaceous gout and SLE was performed. Twenty-six patients were identified. Patients meeting American College of Rheumatism criteria for SLE and crystal-proven gout or a self-limited inflammatory arthritis felt to be crystal-induced (i.e. definite gout) were included.
Ten patients were identified. Their mean age was 46.5 yr; 80% were African-American and 70% were women. Nine of the ten had lupus nephritis and four had undergone renal transplantation. An acute worsening of renal function unrelated to lupus activity preceded almost all gout flares. Lupus activity at the time of the first gout attack as measured by the Systemic Lupus Activity Measure (SLAM) was low. Eight patients were on prednisone (mean dose 8 mg/day) for their SLE at the time the attack of gout occurred.
Gouty arthritis is uncommon in SLE; it occurs primarily in patients with long-standing SLE and nephritis. Worsening renal function usually preceded gout attacks, but SLE disease activity was minimal. Crystal-induced arthritis should be included in the differential diagnosis of a lupus patient presenting with acute inflammatory arthritis because the long-term treatment of the two conditions differs substantially.
研究系统性红斑狼疮（SLE）患者中痛风性关节炎的发病率，并阐明易引发该病的临床因素。
对1989 - 2001年住院患者以及1999 - 2001年门诊患者进行病历回顾，这些患者的ICD9账单编码显示患有痛风性关节炎/痛风石性痛风和SLE。共识别出26例患者。纳入符合美国风湿病学会SLE标准且经晶体证实为痛风或被认为是晶体诱导的自限性炎症性关节炎（即确诊痛风）的患者。
共识别出10例患者。他们的平均年龄为46.5岁；80%为非裔美国人，70%为女性。10例中有9例患有狼疮性肾炎，4例接受了肾移植。几乎所有痛风发作之前都出现了与狼疮活动无关的肾功能急性恶化。首次痛风发作时，通过系统性狼疮活动度量表（SLAM）测量的狼疮活动度较低。8例患者在痛风发作时因SLE正在服用泼尼松（平均剂量8毫克/天）。
痛风性关节炎在SLE中并不常见；主要发生在患有长期SLE和肾炎的患者中。痛风发作前通常会出现肾功能恶化，但SLE疾病活动度较低。对于出现急性炎症性关节炎的狼疮患者，鉴别诊断应包括晶体诱导的关节炎，因为这两种疾病的长期治疗有很大差异。
