Abstract
摘要
Introduction:Goutisadisorderofpurinemetabolism,affectingmen40–50yearsofageresultinginrecurrentboutsofarthritisandsubcutaneoustophiinpatientswithlongstandingdisease.
引言：痛风是一组嘌呤代谢紊乱所致的疾病，发生于40-50岁人群，引起长期患病的患者出现复发性关节炎和皮下痛风石。
CaseReport:Wereportacaseofa45-year-oldmalewithsymmetric,deformingpolyarticulararthritis,affectingallthejointsofhands,wristsandfeetwithdiffusesubcutaneousnodulesoverhisbody.Theradiographicfindingsofthepatientwereatypical.
病例报告：患者，男，45岁。对称，变形的多发性关节炎，影响手、手腕和脚部所有关节，伴全身皮下结节。影响学检查不典型。
Conclusion:Followingclinicalevaluationandadditionalinvestigations,thepatientreceivedadiagnosisofchronictophaceousgoutyarthritismimickingrheumatoidarthritis.
结论：进行临床评估和检查之后，诊断为慢性痛风性关节炎（与类风湿性关节炎相似）。
Keywords:Gout,Arthritis,Tophi,Hand,Foot
关键词：痛风；关节炎；痛风石；手；足
Introduction
引言
Goutisametabolicdisorderofpurinedegradationpathwayusuallyaffectingmiddleagedandelderlymenandpostmenopausalfemales.Usually,itresultsinacute,monoarticulararthritis,intercriticalperiodandchronictophaceousgoutassociatedwithhyperuricemiaandcharacterizedbythepresenceofmonosodiumurate(MSU)crystalsinconnectivetissuesandkidneys.However,somepatientsdevelopchronicpolyarthritismimickingrheumatoidarthritis.Bothdiseaseentitieshavebeenreportedtooccurinadultpopulationtotheextentofapproximately1%withsymmetricpolyarthritis.Symmetricalpresentationorpositiverheumatoidfactor(RF)canbeseeninboththediseases.Afewcasesofpolyarticulartophaceousgouthavebeenreportedinliterature.Wereportararecaseofa45-year-oldmalewithpolyarticulartophaceousgoutwithatypicalinvolvementofhandandfeetwithdisablingeffectsofuntreatedhyperuricemia.
痛风是一组嘌呤代谢紊乱所致的疾病，好发于中年或者老年人群以及绝经后的女性。通常可引起急性关节炎，单关节炎，间歇期和慢性痛风性关节炎伴高尿酸血症，特点为结缔组织和肾脏出现单钠尿酸盐（MSU）沉积。但是，有些患者发展成慢性多关节炎，与类风湿性关节炎相似。上述两种疾病均多发于成年患者，对称性多关节炎约占1%，可见对称性症状或者类风湿因子（RF）阳性。已有文献报道过多关节炎痛风石痛风。本文所述病例为45岁男性多关节痛风性关节炎伴高尿酸血症未治疗引发的非典型的手足累及一例。
CaseReport
病例报告
A45-year-oldmale(fromKashmir)waspresentedtoourdepartmentofphysicalmedicineandrehabilitationatSher-i-KashmirInstituteofMedicalsciences(Srinagar)amultispecialtyhospitalwithlongstandinghistoryofpain,swellinganddeformityofsmallandlargejointsofbothhandsandfeetforapproximately12years.Thepatientreportedwiththehistoryofpolyarthralgiawhichhadimprovedoveraweek’stime.Thiswasfollowedbyfrequentintermittentepisodesofarthritisofsmallandlargejointsofhands,knees,wrists,anklesandfeetwithoutmorningstiffness.Thediseasehadbeentreatedsymptomaticallywithnon-specificnon-steroidanti-inflammatorydrugs(NSAIDs)leadingtotheimprovementoveraperiodoftime.Thereafter,patientdevelopedrecurrentepisodesofpolyarthritiswithpainlessnodulesonhandandfeet.Hewasputonallopurinolfor6monthsanddietaryrestrictionofproteinonaccountofhyperuricemiawithserumuricacidlevelsof12.43mg/dL.Patientintentionallyinterruptedthetreatmentfollowinghisbettermentofhealth.
患者，男，45岁。病史：双手和双脚大小关节疼痛，肿胀，畸形，持续12年。患者称多关节痛近一周来有所缓解。之后手部，膝盖，腕部，踝关节和脚部的大小关节关节炎频繁发作，无晨僵。采取对症治疗，给药非特异性非甾体类抗炎药（NSAIDs）一段时间后症状改善。此后，患者多关节炎症装复发，手部和足部出现结节，无疼痛感。给药别嘌呤醇6个月；患者有高尿酸血症，血尿酸水平为12.43mg/dL，饮食限制蛋白质摄入。情况好转后，患者停止治疗。
Whenthepatientvisitedtheoutpatientdepartmentofourcliniconfirstphysicalexamination,hewasconscious,afebrile,andnormotensive.Cardiovascularandrespiratorysystemparameterswerenormal.PhysicalexaminationofLo哪家医院治白癜风好白癜风治疗贵不贵
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