Mank Victoria M F, Goldstein Elianna, Babb Sean, Meghpara Sanket, Breighner Crystal, Roberts Jefferson
Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA.
Department of Radiology, Tripler Army Medical Center, Honolulu, HI 96859, USA.
Mil Med. 2023 Jan 4;188(1-2):e432-e435. doi: 10.1093/milmed/usab129.
Urate crystal gout arthritis and calcium pyrophosphate deposition disease (CPPD) are crystalline arthropathies seen in middle age to elderly patients, but are also seen in the active duty military population. Flares of either can be identified by acute joint pain, associated swelling, tenderness, and warmth. Definitive diagnosis involves synovial analysis from arthrocentesis. Gout and CPPD are common inflammatory joint diseases. Both arthropathies presenting themselves in the same joint are rather rare. An elderly female with a history of gout presented to the hospital with severe hip pain. She was on urate-lowering therapy at the time, and uric acid levels on admission were not significantly elevated. Radiographic imaging of her hip demonstrated periarticular cartilage calcifications. A review of radiographic imaging over the last 20 years found significant erosive arthropathy in multiple joints and radiographic evidence of chondrocalcinosis, suggesting CPPD. Synovial analysis was not obtained during this admission as the patient declined procedures due to her elderly age. Her condition improved with oral steroids. Few literatures have demonstrated that gout and CPPD are common crystal arthropathies that can occur concomitantly in the same joint. A 20-year review of imaging in an elderly female with known gout arthropathy found that she had radiographic evidence of concomitant CPPD-associated damage to many of her joints. Clinicians should be aware of the different erosive arthropathies, their corresponding imaging findings, evaluation for underlying metabolic disorders if appropriate, and the possibility that they may occur in the same joint. Early prevention can reduce joint destruction later in life.
尿酸盐结晶性痛风性关节炎和焦磷酸钙沉积病（CPPD）是在中年至老年患者中可见的结晶性关节病，但在现役军人中也有发现。两者的发作都可通过急性关节疼痛、相关肿胀、压痛和发热来识别。确诊需要通过关节穿刺进行滑膜分析。痛风和CPPD是常见的炎性关节疾病。两种关节病出现在同一关节的情况相当罕见。一位有痛风病史的老年女性因严重的髋部疼痛入院。她当时正在接受降尿酸治疗，入院时尿酸水平没有明显升高。她髋部的影像学检查显示关节周围软骨钙化。回顾过去20年的影像学检查发现，多个关节存在明显的侵蚀性关节病以及软骨钙质沉着症的影像学证据，提示为CPPD。此次入院期间未进行滑膜分析，因为患者因年龄较大拒绝接受相关检查。她的病情通过口服类固醇得到改善。很少有文献表明痛风和CPPD是常见的结晶性关节病，可在同一关节同时发生。对一位已知患有痛风性关节病的老年女性进行的20年影像学回顾发现，她的许多关节都有与CPPD相关的合并损伤的影像学证据。临床医生应了解不同的侵蚀性关节病、其相应的影像学表现、在适当情况下对潜在代谢紊乱的评估，以及它们可能在同一关节发生的可能性。早期预防可以减少晚年的关节破坏。
