Section of Rheumatology and Immunology, Department of Internal Medicine, National Cheng Kung University Hospital and Dou-Liou Branch.
Clin Exp Rheumatol. 2009 Nov-Dec;27(6):902-6.
To analyse the characteristic features of patients with coexistence of gouty arthritis and pyarthrosis at our university hospital in southern Taiwan, an area with high prevalence of hyperuricemia and gout.
A retrospective chart review was performed for patients who had concomitant gouty and septic arthritis from July 1998 to June 2008. Clinical and laboratory data of these patients were analysed. Furthermore, a comparison was made with published cases in English literature.
Fourteen cases with coexistence of gouty arthritis and pyarthrosis have been identified during the past 10 years. There were 13 male and 1 female, all of Han Chinese in ethnicity, with ages ranging from 45 to 85 and an average of 63.7 years. At disease presentation, there were 11 oligoarticular cases (78.6%), 2 monoarticular cases (14.3%) and 1 polyarticular case (7.1%). Ankle and knee joints were most commonly involved. Bacteriological analyses demonstrated gram-positive cocci in 12 cases, of these 10 were oxacillin-sensitive Staphylococcus aureus (71.4%). Multiple tophi deposition was noted in 13 patients (92.9%) and among them 11 patients (84.6%) had associated chronic kidney disease.
Different clinical presentations and bacteriological characteristics have been identified in the present series. While the mechanisms responsible for such a coexistence remain to be elucidated, these cases underline the importance of thorough evaluation of the aspirated synovial fluid. Our report adds a novel insight into the understanding of the clinical and microbiological manifestations of such a rare concurrence of gouty and septic arthritis.
分析本大学医院（位于台湾南部，为高尿酸血症及痛风盛行地区）同时患有痛风性关节炎与化脓性关节炎患者的特征。
对 1998 年 7 月至 2008 年 6 月期间同时患有痛风性及化脓性关节炎的患者进行回顾性病历分析。分析这些患者的临床和实验室数据，并与英文文献中的已发表病例进行比较。
过去 10 年间共发现 14 例同时患有痛风性关节炎与化脓性关节炎的患者。13 例为男性，1 例为女性，均为汉族，年龄 45 至 85 岁，平均 63.7 岁。发病时，11 例为寡关节炎（78.6%），2 例为单关节炎（14.3%），1 例为多关节炎（7.1%）。最常受影响的关节为踝关节和膝关节。12 例的细菌学分析显示为革兰阳性球菌，其中 10 例为耐苯唑西林的金黄色葡萄球菌（71.4%）。13 例患者（92.9%）有多处痛风石沉积，其中 11 例（84.6%）合并慢性肾脏病。
本研究系列发现了不同的临床表现和细菌学特征。虽然这种共存的机制仍有待阐明，但这些病例强调了对抽吸的滑液进行彻底评估的重要性。本报告为理解痛风性和化脓性关节炎这种罕见同时存在的临床和微生物学表现提供了新的见解。
