Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of atypical gouty arthritis(AGA).Methods A retrospective analysis was performed on the clinical data of 4 patients with gouty arthritis misdiagnosed as other diseases from January 2020 to January 2023.Results Of 4 patients in this group,1 patient presented with symmetrical joint swelling and pain,and a positive rheumatoid factor that was misdiagnosed as rheumatoid arthritis,and 1 patient presented with joint swelling and pain in both knees,and was misdiagnosed as osteoarthritis due to degenerative changes on joint X-ray.One patient was misdiagnosed as ankylosing spondylitis due to inflammatory low back pain and positive physical examinations associated with ankylosing spondylitis,and 1 patient was misdiagnosed with plantar fasciitis because of the pain of the right heel that was consistent with plantar fasciitis.The duration of misdiagnosis was 3 months-5 years.After taking a further medical history,it was found that 4 patients had long-term hyperuricemia and did not respond to the original treatment regimen.Dual-energy CT(DECT)examination was performed in 4 patients,and all of them were diagnosed with gouty arthritis.After the corresponding treatment,the symptoms were significantly relieved.At 6-month follow-up,patient's condition was stable.Conclusion Gouty arthritis with atypical clinical manifestations is more likely to be misdiagnosed and the possibility of gouty arthritis should be considered for patients with arthritis,especially when patients has hyperuricemia.Non-invasive DECT can be used to assist diagnosis in patients highly suspected of gouty arthritis,which can avoid misdiagnosis and mistreatment.
维普
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