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Rare copresent rheumatoid arthritis and gout: comparison with pure rheumatoid arthritis and a literature review.

机译:罕见的共存类风湿关节炎和痛风:与单纯类风湿关节炎的比较和文献综述。

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摘要

Copresent rheumatoid arthritis (RA) and gout is seldom reported. This study summarizes the findings of eight cases of copresent RA and gout and compares them with 31 pure RA cases. Additional reported cases were retrieved from the current literature by Medline search. Patients with copresent RA and gout were older (p = 0.014) and predominantly male (p < 0.01). Synovial fluid, positive for urate crystals, was aspirated most frequently from the knee (five out of eight), followed by the first metatarsophalangeal joint (three out of eight). Serum creatinine and urate levels in the copresent group were significantly higher (p < 0.01, both), and serum hemoglobin was lower (p = 0.04) than those with pure RA. Copresent subjects had much lower percentage of positive rheumatoid factor (RF) tests than patients with pure RA (37.5 vs 80.6%). Only one copresent subject had both RF and anti-cyclic citrullinated peptide antibody. Of copresent subjects, 75% had gouty arthritis before diagnosis of RA, which is consistent with earlier reports. Seven copresent subjects had gout attacks under disease-modifying antirheumatic drug use. This study revealed that polyarthritis negative for RF in a previously gouty patient may be RA and vice versa. This combination occurs more frequently in males. Moreover, anti-CCP antibody examination is not helpful for this diagnosis. Therefore, physicians must obtain synovial fluid for analysis in joints with intense swelling, especially in old RA subjects with renal insufficiency or involvement of lower extremities. Conversely, RA must be considered in gouty patients with polyarticular involvement.
机译:并发类风湿关节炎(RA)和痛风的报道很少。本研究总结了8例同时存在RA和痛风的病例的发现,并将其与31例单纯RA患者进行了比较。通过Medline搜索从当前文献中检索了其他报告的病例。伴有RA和痛风的患者年龄较大(p = 0.014),男性占多数(p <0.01)。滑液对尿酸盐晶体呈阳性,最常从膝盖(八分之五)中抽出,然后是第一个meta趾关节(八分之三)。联合治疗组的血清肌酐和尿酸盐水平明显高于纯RA组(p <0.01),血清血红蛋白较低(p = 0.04)。与普通RA患者相比,共存受试者的类风湿因子阳性(RF)测试百分比低得多(37.5 vs 80.6%)。仅一名同时存在的受试者同时具有RF和抗环瓜氨酸肽抗体。在共存的受试者中,有75%的人在诊断为RA之前患有痛风性关节炎,这与早期报道一致。在改变疾病的抗风湿药的使用下,有七个共同出席的受试者患有痛风发作。这项研究表明,在以前的痛风患者中,RF阴性的多关节炎可能是RA,反之亦然。这种组合在男性中更常见。此外,抗CCP抗体检查对该诊断没有帮助。因此,医师必须获得滑液来分析肿胀严重的关节,特别是在肾功能不全或下肢受累的老年RA患者中。相反,患有多关节受累的痛风患者必须考虑RA。

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