BACKGROUND & AIMS:
BACKGROUND:A 79-year-old woman was referred for evaluation of her painful and swollen joints. She had a medical history of congestive heart failure, renal insufficiency and peptic ulcer disease. For the past 3 years she had experienced recurrent bouts of debilitating arthritis, lasting approximately 3-4 weeks at a time. The symptoms were most severe in the hands and knees, where the joints were warm, swollen and tender. During each flare-up, the patient was housebound and required therapeutic dosing of nonsteroidal anti-inflammatory drugs and codeine to control joint pain.
INVESTIGATIONS:Physical examination, fine-detailed radiographs of the hands, standing radiographs of the knees, arthrocentesis including cell count and gram stain, compensated polarized light microscopy, alizarin-red staining, X-ray diffraction, scanning and transmission electron microscopy with energy dispersive spectrometry, electron microprobe analysis with energy dispersive spectrometry, Fourier transform infrared spectroscopy, and atomic force microscopy.
DIAGNOSIS:Carbonated-substituted apatite arthropathy.
MANAGEMENT:Both knees were aspirated and large volumes of a straw-colored synovial fluid was removed. The knees were injected with corticosteroid, resulting in excellent symptomatic response.
背景与目标:
背景:一名79岁的妇女被要求评估她的关节疼痛和肿胀。她有充血性心力衰竭,肾功能不全和消化性溃疡病的病史。在过去的三年中,她经历了反复发作的衰弱性关节炎发作,一次持续约3-4周。症状最严重的地方是手和膝盖,那里的关节温暖,肿胀和触痛。在每次发作期间,该患者待在屋内,需要非甾体抗炎药和可待因的治疗剂量以控制关节痛。
调查:体格检查,手部细微X线照片,膝盖站立X线照片,关节穿刺术(包括细胞计数和革兰氏染色),补偿偏振光显微镜,茜素红染色,X射线衍射,扫描和透射电子显微镜(能量分散)光谱分析,带能量色散光谱的电子显微探针分析,傅立叶变换红外光谱和原子力显微镜。
诊断:碳取代磷灰石关节炎。
处理:吸除两个膝盖,并去除大量稻草色滑液。膝关节注射皮质类固醇激素,可产生出色的症状反应。