Fam A G, Reis M D, Szalai J P
Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
J Rheumatol. 1997 Dec;24(12):2389-93.
To analyze the clinical features of acute gouty synovitis associated with thick, milky white, "chalky," urate laden synovial effusions, and to investigate the effects on synovial white blood cell (WBC) counts when leukocyte-rich rheumatoid effusions are incubated with a urate packed milky synovial fluid.
Five patients (all men, mean age 70.8 years) with acute gouty synovitis (acute arthritis in 3, acute bursitis in 2) associated with "urate milk" were studied between 1993 and 1996.
Synovial effusions were thick, "chalky," and appeared "milky" white. The fluids were packed with monosodium urate (MSU) crystals, which sedimented upon standing, leaving a clear supernatant containing a few MSU crystals. The presence of massive amounts of MSU crystals and crystal clumps interfered with accurate determination of synovial WBC counts. Four fluids showed "a few leukocytes," and one a WBC count of 6750/mm3 with 91% neutrophils and several intraleukocytic crystals. Four patients had subcutaneous tophi. Of the risk factors associated with development of gout, the most frequent was ethanol abuse, in 4 and possibly all 5 patients. Incubation of leukocyte-rich rheumatoid synovial effusions with urate laden knee fluid from Patient 5 produced a greater reduction in synovial WBC counts compared to controls.
Milky white synovial effusions containing massive quantities of urate crystals (referred to as "urate milk") may rarely occur in the setting of acute gouty arthritis or bursitis. Ethanol abuse appears to be a risk factor associated with the development of hyperuricemia and gout in these patients.
分析伴有浓稠、乳白色、“白垩样”、富含尿酸盐的滑液渗出的急性痛风性滑膜炎的临床特征，并研究当富含白细胞的类风湿性渗出液与充满尿酸盐的乳白色滑液一起孵育时，对滑膜白细胞（WBC）计数的影响。
对1993年至1996年间5例伴有“尿酸盐乳”的急性痛风性滑膜炎（3例为急性关节炎，2例为急性滑囊炎）患者（均为男性，平均年龄70.8岁）进行研究。
滑膜渗出液浓稠、呈“白垩样”，外观为“乳白”色。液体中充满了尿酸单钠（MSU）晶体，静置后会沉淀，留下清澈的上清液，其中含有少量MSU晶体。大量MSU晶体和晶体团块的存在干扰了滑膜WBC计数的准确测定。4份液体显示“少量白细胞”，1份液体的WBC计数为6750/mm³，中性粒细胞占91%，并有多个白细胞内晶体。4例患者有皮下痛风石。在与痛风发生相关的危险因素中，最常见的是乙醇滥用，4例患者存在该情况，可能所有5例患者均有。与对照组相比，将富含白细胞的类风湿性滑膜渗出液与患者5的充满尿酸盐的膝关节液一起孵育后，滑膜WBC计数下降幅度更大。
含有大量尿酸盐晶体（称为“尿酸盐乳”）的乳白色滑膜渗出液可能很少出现在急性痛风性关节炎或滑囊炎的情况下。乙醇滥用似乎是这些患者高尿酸血症和痛风发生的一个危险因素。
