Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan.
Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
Mod Rheumatol Case Rep. 2020 Jan;4(1):110-115. doi: 10.1080/24725625.2019.1662987. Epub 2019 Sep 16.
Gout, which is characterized by the deposition of monosodium urate monohydrate (MSU) in the synovial fluid and other tissues, is the most common form of inflammatory arthritis. Unlike the easily recognized acute and monoarticular gouty arthritis, advanced gout induces multiple finger joint disorders and may sometimes mimic rheumatoid arthritis (RA) or vice versa. The gold standard for gout diagnosis is the identification of MSU crystals via aspiration in the symptomatic joints or nodules; however, its feasibility and specificity may be inadequate. Recently, there have been important advances in imaging techniques, assisting in the non-invasive diagnosis of gout. Ultrasonography (US) has been known to have the ability to detect deposition of MSU crystals in patients with gout. Herein, we report an evocative case of long-standing gout with precisely detected specific US features indicating MSU crystal deposition and inflammation in multiple joints. Comprehensive US assessment included the bone, hyaline cartilage, soft tissue, subcutaneous nodules and tendon; we also discriminated gouty arthritis from RA.
痛风是一种以滑液和其他组织中单水尿酸单钠（MSU）沉积为特征的疾病，是最常见的炎症性关节炎形式。与易于识别的急性单关节炎性痛风性关节炎不同，晚期痛风会引起多个手指关节疾病，有时可能类似于类风湿关节炎（RA），反之亦然。痛风诊断的金标准是在有症状的关节或结节中抽吸以鉴定 MSU 晶体；然而，其可行性和特异性可能不足。最近，成像技术取得了重要进展，有助于痛风的非侵入性诊断。超声检查（US）已被证明能够检测到痛风患者 MSU 晶体的沉积。在此，我们报告了一例长期痛风的案例，其特征性超声表现可精确检测到多个关节的 MSU 晶体沉积和炎症。全面的 US 评估包括骨骼、透明软骨、软组织、皮下结节和肌腱；我们还区分了痛风性关节炎和 RA。
