不典型痛风性关节炎误诊分析并文献复习

Analysis of Misdiagnosis of Atypical Gouty Arthritis and Literature Review

目的探讨不典型痛风性关节炎的临床特点及误诊原因、防范措施。方法回顾性分析2020年1月—2023年1月收治的曾误诊的痛风性关节炎4例的临床资料,并复习相关文献。结果本组4例中1例因关节对称肿痛及类风湿因子阳性误诊为类风湿关节炎;1例双膝关节肿痛,因关节X线检查提示退行性改变误诊为膝关节骨性关节炎;1例因炎性下腰部疼痛及强直性脊柱炎常见查体阳性误诊为强直性脊柱炎;1例因右足跟疼痛符合足底部筋膜炎特点误诊为足底部筋膜炎。误诊时间3个月~5年。后经追问病史,4例长期存在高尿酸血症且原治疗方案无效,遂进行双能CT检查,均确诊为痛风性关节炎。给予相应治疗,症状皆明显缓解。随访6个月,病情平稳。结论临床表现不典型痛风性关节炎患者容易误诊。临床上对合并高尿酸血症关节炎患者要考虑到痛风性关节炎可能,对高度怀疑该病患者可采用无创双能CT检查进行诊断,以减少或避免误诊误治。

Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of atypical gouty arthritis(AGA).Methods A retrospective analysis was performed on the clinical data of 4 patients with gouty arthritis misdiagnosed as other diseases from January 2020 to January 2023.Results Of 4 patients in this group,1 patient presented with symmetrical joint swelling and pain,and a positive rheumatoid factor that was misdiagnosed as rheumatoid arthritis,and 1 patient presented with joint swelling and pain in both knees,and was misdiagnosed as osteoarthritis due to degenerative changes on joint X-ray.One patient was misdiagnosed as ankylosing spondylitis due to inflammatory low back pain and positive physical examinations associated with ankylosing spondylitis,and 1 patient was misdiagnosed with plantar fasciitis because of the pain of the right heel that was consistent with plantar fasciitis.The duration of misdiagnosis was 3 months-5 years.After taking a further medical history,it was found that 4 patients had long-term hyperuricemia and did not respond to the original treatment regimen.Dual-energy CT(DECT)examination was performed in 4 patients,and all of them were diagnosed with gouty arthritis.After the corresponding treatment,the symptoms were significantly relieved.At 6-month follow-up,patient's condition was stable.Conclusion Gouty arthritis with atypical clinical manifestations is more likely to be misdiagnosed and the possibility of gouty arthritis should be considered for patients with arthritis,especially when patients has hyperuricemia.Non-invasive DECT can be used to assist diagnosis in patients highly suspected of gouty arthritis,which can avoid misdiagnosis and mistreatment.