ＲＡとの鑑別に難渋した慢性痛風性関節炎の１例

Abstract

We report a 69-year-old female with gout who showed polyarthritis in the upper and lower limbs. She developed pain in multiple joints of the upper and lower limbs in 1987 and was diagnosed as having rheumatoid arthritis (RA) and treated in a local hospital. In January, 1996, she visited our department because of increased pain in multiple joints. At the time of the initial consultation, symmetrical swelling and pain were observed mainly in the finger MP·PIP joints of the bilateral hands and the toe MP joint. The fingers showed swan-neck deformity, boutonniere deformity, and Z deformity of the thumbs while the toes showed hallux varus and mallet toe deformity. X-ray examination revealed bone atrophy and destruction of the bilateral carpi. Hyperuricemia was also observed. Arthroscopic synovectomy of the knee joint and metatarsal osteotomy arthroplasty were performed for the swelling and pain of the right knee and deformities of the right foot. Subsequently, synovectomy of the left wrist and arthrodesis of the right index finger PIP joint and the right thumb IP joints were performed. During operation, white crystal deposition was observed on the joint surface, and histological examination demonstrated gouty arthritis.