Chen ZY, Ou-Yang MH, Li SW, Ou R, Chen ZH, Wei S. Concomitant atypical knee gout and seronegative rheumatoid arthritis: A case report. World J Clin Cases 2024; 12(22): 5245-5252 [PMID: 39109047 DOI: 10.12998/wjcc.v12.i22.5245]
Corresponding Author of This Article
Zhi-Huang Chen, PhD, Professor, Department of Chinese Medicine, General Hospital of Southern Theater Command, No. 111 Liuhua Road, Yuexiu District, Guangzhou 510010, Guangdong Province, China. 18665032046@163.com
Research Domain of This Article
Rheumatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zhou-Yi Chen, Zhi-Huang Chen, Song Wei, Department of Chinese Medicine, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China
Min-Hua Ou-Yang, Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Shao-Wei Li, The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Rui Ou, Department of Gout, Guangdong Hydropower Hospital, Guangzhou 511340, Guangdong Province, China
Author contributions: Chen ZY, Li SW, and Chen ZH crafted the research protocols for minimally invasive diagnostics and treatments and significantly contributed to the synthesis of case reports; Chen ZY, Ou R, Ou-Yang MH, and Wei S not only provided critical contributions to the clinical management of patients but also collected samples; Chen ZY, Ou-Yang MH, and Ou R analyzed patient medical records, synovial pathology, and joint fluid; Chen ZY and Li SW wrote the manuscript. All authors have read and approved the final manuscript.
Supported byNatural Science Foundation of Guangdong Province, No. 2023A1515011213.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist, and the manuscript was prepared and revised according to the CARE Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Huang Chen, PhD, Professor, Department of Chinese Medicine, General Hospital of Southern Theater Command, No. 111 Liuhua Road, Yuexiu District, Guangzhou 510010, Guangdong Province, China. 18665032046@163.com
Received: April 15, 2024 Revised: June 11, 2024 Accepted: June 24, 2024 Published online: August 6, 2024 Processing time: 77 Days and 15.8 Hours
Abstract
BACKGROUND
Gout and seronegative rheumatoid arthritis (SNRA) are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported. Limited information is available regarding the clinical management and prognosis of these combined diseases.
CASE SUMMARY
A 57-year-old woman with a 20-year history of joint swelling, tenderness, and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA. The initial regimen of methotrexate, leflunomide, and celecoxib alleviated her symptoms, except for those associated with the knee. After symptom recurrence after medication cessation, her regimen was updated to include iguratimod, methotrexate, methylprednisolone, and folic acid, but her knee issues persisted. Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee, indicating coexistent SNRA and atypical knee gout. After postarthroscopic surgery to remove the synovium and urate crystals, and following a tailored regimen of methotrexate, leflunomide, celecoxib, benzbromarone, and allopurinol, her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year, indicating successful management of both conditions.
CONCLUSION
This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.
Core Tip: Addressing the rare co-occurrence of seronegative rheumatoid arthritis and atypical knee gout, this case reinforces the diagnostic and therapeutic challenges inherent in rheumatology. This highlights the necessity for clinicians to maintain a high degree of suspicion for atypical disease presentations and the importance of personalized, innovative treatment strategies. The successful outcome in this case, achieved through a combination of minimally invasive diagnostic techniques and a customized treatment plan, provides valuable insights for the effective management of similar complex cases.
