Chen Zhou-Yi, Ou-Yang Min-Hua, Li Shao-Wei, Ou Rui, Chen Zhi-Huang, Wei Song
Department of Chinese Medicine, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China.
Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China.
World J Clin Cases. 2024 Aug 6;12(22):5245-5252. doi: 10.12998/wjcc.v12.i22.5245.
Gout and seronegative rheumatoid arthritis (SNRA) are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported. Limited information is available regarding the clinical management and prognosis of these combined diseases.
A 57-year-old woman with a 20-year history of joint swelling, tenderness, and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA. The initial regimen of methotrexate, leflunomide, and celecoxib alleviated her symptoms, except for those associated with the knee. After symptom recurrence after medication cessation, her regimen was updated to include iguratimod, methotrexate, methylprednisolone, and folic acid, but her knee issues persisted. Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee, indicating coexistent SNRA and atypical knee gout. After postarthroscopic surgery to remove the synovium and urate crystals, and following a tailored regimen of methotrexate, leflunomide, celecoxib, benzbromarone, and allopurinol, her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year, indicating successful management of both conditions.
This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.
痛风和血清阴性类风湿关节炎（SNRA）是两种不同的炎性关节疾病，其共现情况相对较少被报道。关于这些合并疾病的临床管理和预后的信息有限。
一名57岁女性，有20年关节肿胀、压痛和晨僵病史，类风湿因子阴性且尿酸水平正常，被诊断为SNRA。甲氨蝶呤、来氟米特和塞来昔布的初始治疗方案缓解了她的症状，但与膝关节相关的症状除外。停药后症状复发，她的治疗方案更新为包括艾拉莫德、甲氨蝶呤、甲泼尼龙和叶酸，但她的膝关节问题仍然存在。微创针刀镜治疗显示膝关节有增生的血管翳和针状晶体，表明同时存在SNRA和非典型膝关节痛风。关节镜手术后切除滑膜和尿酸盐晶体，并采用甲氨蝶呤、来氟米特、塞来昔布、苯溴马隆和别嘌醇的定制治疗方案后，她的膝关节症状明显缓解，一年多未复发，表明两种疾病均得到成功管理。
本研究报告了一例同时患有膝关节非典型痛风和SNRA的患者病例，并强调了微创关节技术作为风湿病学和免疫学领域有效诊断和治疗工具的重要性。
