10例痛风合并类风湿关节炎临床分析及文献复习

Coexistent gout and rheumatoid arthritis:Report of 10 cases with literature review

目的:追踪研究类风湿关节炎(RA)和痛风并存的发病情况,了解其临床特征及诊治方法。方法:收集2006年8月~2019年7月RA和痛风并存的病例,并纳入同时符合1987年美国风湿病协会修订的RA分类标准和1977年美国风湿病协会痛风诊断标准的病例,回顾性分析病例的一般资料、合并疾病、实验室检查及影像资料。结果:有10例患者符合以上诊断标准,均为男性,年龄25~77岁,8例(80%)患者痛风发病在前,9例(90%)患者血尿酸升高,7例(70%)患者类风湿因子阳性,4例患者双源CT显示有尿酸盐结晶,1例患者皮下结节证实为痛风石,大部分病例有不同程度的类风湿关节炎或痛风性骨破坏,但是有3例无影像学改变。结论:虽然以往的观念认为RA很少和痛风并存,但是这样的病例确实存在,研究这类患者有助于我们更好地认识这类疾病,早期诊断,早期合理治疗。

Objective:To follow case series of patients with coexistent rheumatoid arthritis and gout to understand its clinical characteristics and diagnosis and treatment methods.Methods:Retrospective analysis was performed in patients with coexistent gout and rheumatoid arthritis,admitted to and treated in our hospital between August 2006 and July 2019,regarding the general demographic information,comorbidities,laboratory findings and imaging data.The inclusion criteria were complied with the 1987 ARA Revised Classification Criteria for RA and 1977 ARA Classification Criteria for Gout.Results:Ten cases were met with the above two diagnostic criteria.All patients were males,aged from 25 to 77 years.Gout was initially diagnosed before development of RA in 8(80%)patients.Elevated blood uric acid was seen in 9(90%),and positive rheumatoid factor was identified in 7(70%)patients.Dual-energy CT revealed urate crystal in 4 patients.Subcutaneous nodules in one patients were confirmed gout stones.Bone erosion associated with RA or gout was seen in most cases,yet unchanged imaging was found in 3 cases.Conclusion:Rheumatoid arthritis and gout do coexist in the same patient,which is contrary to previous consensus.Further and wide investigation on such cases may contribute to better recognition,early diagnosis and planning of rational treatment options.