Attack of Gouty Arthritis after Intraarticular Injection of Naturally Derived Hyaluronic Acid

關節內注射玻尿酸已被認為是膝退化性關節炎的有效治療方法之一。注射後可能發生的副作用，包括局部疼痛、腫脹、與過敏反應，但並不常見；即使發生這些副作用，症狀多半相當輕微、短暫，且為自限性。本病例報告為一80歲男性病患，因膝退化性關節炎接受關節內注射天然成份之玻尿酸製劑後，出現急性關節腫痛。膝關節經由穿刺，抽吸出40毫升混濁之關節液。關節液之細胞計數顯示有大量以嗜中性球為主之白血球，置於偏光顯微鏡下檢查可見呈陰性雙極偏光之針狀結晶被吞噬於白血球細胞內，此為急性痛風性關節炎發作所特有之單鈉尿酸鹽結晶。關節液之細菌培養則為陰性。病患在經由關節液抽吸與口服非類固醇類消炎止痛藥後，關節疼痛的症狀大幅緩解。回顧文獻，此病例應為注射天然成份玻尿酸後引發痛風發作之首例報告，本文也針對此副作用發生的可能機轉做詳盡的探討。

關鍵字

玻尿酸；退化性關節炎；痛風

並列摘要

Viscosupplementation by intraarticular administration of exogenous hyaluronic acid has been a favorable treatment option to alleviate the symptoms of knee osteoarthritis. The potential but uncommon adverse reactions associated with intraarticular hyaluronic acid injection are local pain, swelling, and allergic response. These reactions are typically mild, transient, and self-limiting. The focus of this report is an 80-year-old man who presented with acute painful swelling of his knee joint after an injection of naturally derived hyaluronic acid. Aspiration of knee joint effusion yielded 40 mL of turbid straw-colored fluid. Synovial fluid cell counts revealed numerous leukocytes with a marked predominance of neutrophils. Intraleukocytic needle-shaped crystals with intensely negative birefringence were identified with polarized light microscopy, indicating monosodium urate crystals that are typically seen in acute gouty arthritis. The synovial fluid was sterile in culture. His knee pain reduced significantly after arthrocentesis and non-steroidal anti-inflammatory drug treatment. To the best of our knowledge, this is the first description of an attack of acute gout following intraarticular injection of naturally derived hyaluronic acid. The possible mechanisms were discussed with a review of the relevant literature.

並列關鍵字

hyaluronic acid ； osteoarthritis ； gout

國際替代計量

Attack of Gouty Arthritis after Intraarticular Injection of Naturally Derived Hyaluronic Acid

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