Ma Wen-Jing, Xiong Yan, Li Jian
Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
Zhongguo Gu Shang. 2024 Jul 25;37(7):664-9. doi: 10.12200/j.issn.1003-0034.20230934.
To analyze the differences of clinical features of acute gout flare and postoperative infection under arthroscopy of knee gouty arthritis patients to offer guiding opinions of clinical diagnosis and treatment.
Between January 2017 and December 2022, 235 patients with gouty knee osteoarthritis were admitted, and underwent arthroscopic debridement combined with synovectomy. Among them, 35 cases had fever with a temperature higher than 38 °C postoperatively while acute inflammatory appears under redness, swelling, heat and pain of the operated joints. There were 29 males and 6 females, with an average age of (41.48±13.90) years old. Among them 23 patients were diagnosed with acute gout attack, and recovered well after being given colchicine and prednisolone;12 patients were diagnosed with postoperative joint infection, and were cured after being given anti-infective treatments and cleaning and rinsing of the joint cavity. The two groups of patients were compared and analyzed in terms of preoperative general data, surgical conditions, hematology, joint fluid, limb function and other clinical characteristics.
There were no significant difference in the preoperative general data between two groups. The onset of fever in the postoperative acute gout flare group occurred mostly within 48 hours, significantly earlier than that in the postoperative infection group(=0.037). The visual analogue scale score was significantly higher in the acute gout flare group (5.32±1.38) score than in the postoperative infection group (2.45±0.68) score (=0.000), while 14 patients with acute gout flare were accompanied by severe pain in other joints. Hematologically, indicators such as white blood cell counts and ratios were significantly higher in both groups. In terms of inflammatory indicators, IL-6, erythrocyte sedimentation rate, procalcitonin and other inflammatory indicators were significantly elevated in both groups, but there was no statistical difference between two groups. The C-reactive protein level in the postoperative infection group (220.97±116.30) mg·L was higher than that in the postoperative acute gout attack group(120.67±82.45) mg·L(=0.006). Blood uric acid (316.55±112.84) μmol·L was higher in the acute postoperative gout flare group than in the postoperative infection group (159.14±126.92) μmol·L(=0.001). In the joint fluid examination of the postoperative infection group, the glucose metabolism indicator was significantly lower than that of the acute gout flare group, and five of them had positive bacterial cultures.
The symptoms of acute gout flare could be mistaken as postoperative infection due to their similarity, therefore requires careful differentiation. Differential diagnosis should be based on a combination of clinical signs, hematology and joint fluid findings, and targeted treatment should be given to avoid serious complications.
分析膝关节痛风性关节炎患者急性痛风发作与关节镜术后感染的临床特征差异，为临床诊断与治疗提供指导意见。
选取2017年1月至2022年12月收治的235例痛风性膝骨关节炎患者，行关节镜下清理联合滑膜切除术。其中35例术后出现发热，体温高于38℃，手术关节出现红、肿、热、痛等急性炎症表现。男29例，女6例，平均年龄（41.48±13.90）岁。其中23例诊断为急性痛风发作，给予秋水仙碱和泼尼松龙后恢复良好；12例诊断为术后关节感染，给予抗感染治疗及关节腔冲洗清理后治愈。对两组患者的术前一般资料、手术情况、血液学、关节液、肢体功能等临床特征进行比较分析。
两组术前一般资料差异无统计学意义。术后急性痛风发作组发热多在术后48小时内出现，明显早于术后感染组（P=0.037）。急性痛风发作组视觉模拟评分（5.32±1.38）分明显高于术后感染组（2.45±0.68）分（P=0.000），且急性痛风发作组有14例伴有其他关节剧痛。血液学方面，两组白细胞计数及比例等指标均明显升高。炎症指标方面，两组白细胞介素-6、红细胞沉降率、降钙素原等炎症指标均明显升高，但两组间差异无统计学意义。术后感染组C反应蛋白水平（220.97±116.30）mg·L高于术后急性痛风发作组（120.67±82.45）mg·L（P=0.006）。术后急性痛风发作组血尿酸（316.55±112.84）μmol·L高于术后感染组（159.14±126.92）μmol·L（P=0.001）。术后感染组关节液检查中，葡萄糖代谢指标明显低于急性痛风发作组，且其中5例细菌培养阳性。
急性痛风发作症状因与术后感染相似易被误诊，需仔细鉴别。应结合临床体征、血液学及关节液检查结果进行鉴别诊断，并给予针对性治疗，以避免严重并发症。
