Sewell K L, Petrucci R, Keiser H D
Department of Internal Medicine, Bronx Municipal Hospital, Albert Einstein College of Medicine, Bronx, New York.
J Am Geriatr Soc. 1991 Apr;39(4):403-6. doi: 10.1111/j.1532-5415.1991.tb02909.x.
Polyarticular gout may be misdiagnosed in the elderly. This reflects the confusing clinical presentation of "diuretic gout" in the elderly, characterized by polyarticular onset, subacute symptoms, hand involvement, and early development of tophi. A misdiagnosis of rheumatoid arthritis can lead to poor treatment of gout, failure to recognize underlying renal insufficiency, and associated cardiac risks. Hyperuricemia may reflect systemic ATP depletion in acutely ill patients and thus represents a predictor for mortality. Medical treatment of polyarticular gout in elderly patients with compromised cardiac and renal function requires recognition of the clinical profile and consideration of the increased toxicity from standard therapies.
多关节型痛风在老年人中可能会被误诊。这反映了老年人“利尿剂性痛风”令人困惑的临床表现，其特征为多关节起病、亚急性症状、手部受累以及痛风石的早期形成。类风湿关节炎的误诊会导致痛风治疗不佳、未能识别潜在的肾功能不全以及相关的心脏风险。高尿酸血症可能反映了急性病患者全身ATP的消耗，因此是死亡率的一个预测指标。对于心脏和肾功能受损的老年患者，多关节型痛风的药物治疗需要认识其临床特征，并考虑标准疗法毒性增加的情况。
