Zhao Guowang, Wang Xuan, Fu Ping
Department of Rheumatology and Clinical Immunology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
Medicine (Baltimore). 2018 Dec;97(50):e13540. doi: 10.1097/MD.0000000000013540.
Rheumatoid arthritis (RA) and gout are common rheumatic diseases. However, their coexistance has been rarely reported. Here in, we describe a case of a middle aged Chinese woman having RA complicated with atypical gout on both the knee joints.
A 44-year-old Chinese woman complained of swelling and tenderness of multiple joints since 10 months. She had a positive rheumatoid factor and high titers of anti-CCP antibody. She was diagnosed with RA, and commenced on methotrexate, leflunomide, and methylprednisolone. Her symptoms of pain and swelling over interphalangeal and wrists joints subsided except the knee joints. She was started with treat to target treatment (TTT) for RA and rest of her medications was adjusted accordingly. Surprisingly, her symptoms did not improve ever after the addition of a biologic agent, tumor necrosis factor (TNF)-α receptor antagonist.
Presence of urate crystals in the synovium was viewed under polarization microscope which was extracted from one of the knee joint. Hence, we established the diagnosis of RA complicated with gout.
We commenced her on TNF-α receptor antagonist, colchicines, and febuxostat.
Her symptoms of pain and swelling improved significantly on both the knees and no longer recurred.
Coexistence of RA and gout has been rarely reported as it is not frequently seen in clinical practice. Hence, when patients with RA with oligoarthritis repeatedly do not respond to TTT, a standard antirheumatism treatment, the possibility of RA complicating with gout should be rule out.
类风湿性关节炎（RA）和痛风是常见的风湿性疾病。然而，它们同时存在的情况鲜有报道。在此，我们描述一例中年中国女性病例，其患有类风湿性关节炎并伴有双侧膝关节非典型痛风。
一名44岁的中国女性自10个月前开始出现多个关节肿胀和压痛。她的类风湿因子呈阳性，抗环瓜氨酸肽抗体滴度高。她被诊断为类风湿性关节炎，并开始使用甲氨蝶呤、来氟米特和甲基泼尼松龙治疗。她指间关节和腕关节的疼痛和肿胀症状消退，但膝关节症状仍存在。她开始接受类风湿性关节炎的达标治疗（TTT），并相应调整了其他药物。令人惊讶的是，即使添加了生物制剂肿瘤坏死因子（TNF）-α受体拮抗剂后，她的症状仍未改善。
在偏振显微镜下观察从一个膝关节提取的滑膜中的尿酸盐结晶。因此，我们确诊为类风湿性关节炎合并痛风。
我们让她开始使用TNF-α受体拮抗剂、秋水仙碱和非布司他。
她双膝的疼痛和肿胀症状明显改善，且未再复发。
类风湿性关节炎和痛风同时存在的情况鲜有报道，因为在临床实践中并不常见。因此，当类风湿性关节炎寡关节炎患者对标准抗风湿治疗TTT反复无反应时，应排除类风湿性关节炎合并痛风的可能性。
