Rheumatology Associates, 10839 124 Street, Edmonton, AB, Canada.
University of Alberta, 8-130 Clinical Sciences Building, Edmonton, AB, Canada.
Clin Rheumatol. 2017 Dec;36(12):2835-2838. doi: 10.1007/s10067-017-3856-6. Epub 2017 Oct 12.
Since 1964 to present, there have been more than 33 cases of concomitant rheumatoid arthritis (RA) and gout reported in the literature. The objective of this study is to present a case series of patients with coexistent rheumatoid arthritis and gout and to provide a review of the literature. A retrospective review of a rheumatology patient database at the University of Alberta was performed (2004-2017). Patient charts were reviewed and the 1987 ARA Revised Classification Criteria for RA and 1977 ARA Classification Criteria for gout were applied to each patient. For gout, positive monosodium urate crystals on synovial fluid analysis, synovial/node biopsy, or positive dual-energy CT-gout protocol were used to satisfy the diagnosis of gout if available. Thirteen patients were identified with both RA and gout (nine men and four women). The mean age was 68.6, while the mean age at the onset of first disease was 55.3 and onset of second disease was 64.4. Eight patients were initially diagnosed with RA and subsequently developed gout, while five patients were first diagnosed with gout and subsequently developed RA. Standard radiographs showed findings characteristic of RA and gout in affected joints. In joints affected by both diseases, the gout findings predominated and the RA changes were milder. Rheumatoid arthritis and gout do coexist in the same patient, contrary to popular belief. Understanding that both conditions can occur concomitantly is necessary for clinical awareness, especially in patients with polyarticular disease that is difficult to treat.
自 1964 年至今,文献中已有超过 33 例类风湿关节炎(RA)合并痛风的病例报道。本研究旨在报告一组同时患有类风湿关节炎和痛风的患者,并对文献进行回顾。我们对阿尔伯塔大学风湿病患者数据库(2004-2017 年)进行了回顾性研究。对患者的病历进行了回顾,并应用 1987 年修订的 ARA 类风湿关节炎分类标准和 1977 年 ARA 痛风分类标准对每位患者进行了评估。对于痛风,如果有条件,滑液分析、滑膜/结节活检或双能 CT-痛风方案阳性的单钠尿酸盐结晶可用于确诊痛风。共发现 13 例同时患有 RA 和痛风(9 名男性和 4 名女性)。患者的平均年龄为 68.6 岁,首发 RA 的平均年龄为 55.3 岁,首发痛风的平均年龄为 64.4 岁。8 例患者最初被诊断为 RA,随后发展为痛风,5 例患者最初被诊断为痛风,随后发展为 RA。标准 X 线片显示受累关节有 RA 和痛风的特征性表现。在同时患有两种疾病的关节中,痛风表现更为突出,RA 改变较轻。与普遍观点相反,类风湿关节炎和痛风确实可以同时存在于同一患者中。了解这两种疾病可以同时发生对于临床意识非常必要,尤其是在治疗困难的多关节疾病患者中。
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