薦腸骨關節痛風，一病例報告及文獻探討

Tophaceous Gout with Sacroiliac Involvement: a Case Report and Literature Review

尿酸鹽結晶常沉積在四肢關節及關節週圍組織。至於沉積在薦腸骨關節則非常少見。本文描述一位41歲男性病人，有12年痛風病史。在最近一個月因四肢有多發性及對稱性關節炎，且無法自由行動而住院治療。最近六年，在四肢關節出現大少不等痛風石，但病人並未接受有效降尿酸藥物治療。最近一年，有間歇性下背痛出現。最近九個月，左側下肢跛行。骨盆X光檢查發現左側股骨頭部截斷，右側薦腸關節有糜爛。骨盆的電腦斷層造影發現薦腸骨關節內的腸骨側關節面有明顯骨內糜爛，且有硬化邊緣，但在薦骨面卻無明顯破壞。此放射線造影特徵提示右側薦腸骨關節及左髖關節結石性痛風。經細針抽取右側薦腸骨關節液，在偏光顯微鏡下檢查發現尿酸鹽結晶沉積。經每天服用Voltaren 200mg一週後，關節炎症狀好轉。本文提出薦腸骨關節痛風難於早期發現，主因症狀不明顯、普通X光變化為非特異性、以及臨床上要有高度警覺性。

Deposition of urates in soft tissues is commonly found in gout, most frequently in para-articular areas and in articular cartilage of the limbs. However, involvement of such deposits in the sacroiliac (SI) joints has been regarded as relatively unusual. In this report we describe the case of a 41-year-old man with a 12-year history of gout. Although development of multiple large and small tophi in bilateral elbows, hands, knees and ankle had been noted during the 6 years prior to examination, he received treatment only when symptomatic. Low back pain had also developed in the recent one year and he had been unable to stand on the left leg for nine months prior to examination. A radiograph of the pelvis showed flattening and amputation of the left femoral head but bilateral SI joints were relatively normal. Computed tomography of the pelvis showed intraosseous bony erosion with sclerotic margin at the right posterior iliac bone and severe bony erosion over the left acetabular articular surface with massive effusion. These radiologic findings were comaptible with involvement of the right SI joint and left hip. Polarizing microscopy of needle aspirates from the right SI joint showed monsodium urate crystals. He was treated with voltaran 200 mg/day orally for 1 week and joint pain subsided. Early diagnosis of SI tophaceous gout is difficult because of the relatively asymptomatic nature of the condition and nonspecific roentgenographic findings.