| Objective The incidence of gouty arthritis is increasing year by year.Especially in the high altitude environment,the incidence of gouty arthritis exceeds the national average.Due to poor patient compliance and some doctors lack knowledge about the disease,resulting in frequent recurrence of gouty arthritis.The formation of gout stone causes loss of joint function and affects the quality of life of patients.Reviewing the clinical features of gouty arthritis under high altitude conditions,observing the relationship between gouty acid and hemoglobin,exploring the necessity of surgical treatment of tophi,strengthening the understanding of the disease,standardizing the diagnosis and treatment process,and reducing missed diagnosis and misdiagnosis.Provide basic information for diagnosis and treatment of gouty arthritis in the highland area and comprehensive prevention.Methods We analyzed data of 208 gouty arthritis patients who diagnosed in Department of Orthopaedics and Rheumatology and Immunology of People’s Hospital of Tibet Autonomous Region from January 1,2013 to December 31,2016.Telephoning follow-up for those who have no information,and screening patients who have long lived in the high altitude environment(≥10 years).They were grouped according to their age.They were divided into youth group(age <45 years)andmiddle-aged and elderly group(age ≥ 45 years).We analyzed gouty arthritis patients’ age,gender,nationality,occupation,duration,predisposing factors,personal life history,involved joints,auxiliary examination,misdiagnosis and treatment.Results 1.The age of onset of gouty arthritis was(49.51±13.08)years old,which was lower than that reported in related literature.2.The young group was found in males(102/102,100%),and the middle-aged and elderly group males(99/106,93.40%)and females(7/106,6.60%)were all visible.The difference was statistically significant(P<0.05).3.The young group of Tibetan(53/102,51.96%)and Han(49/102,48.04%)were more common.The middle-aged and elderly group was more common in Tibetans(90/106,84.91%).The difference was significant(P<0.05).4.The young group was more common in civil servants(41 cases,40.20%);the middle-aged and elderly group was more common in farmers and herdsmen(47 cases,44.34%).5.The predisposing factors were different in the young and middle-aged groups.6.The young group was more common in those with normal BMI(58/102,56.86%).The middle-aged and elderly group was more common in overweight persons(53/106,50.00%).The difference was significant(P<0.05).7.The most common first site of gouty arthritis was the first metatarsophalangeal joint(133/208,63.94%).The first site of attack in the young(57/102,55.88%)and middle-aged and elderly group(76/106,71.70%)was the first metatarsophalangeal joint(P> 0.05).8.The middle-aged and elderly group mostly involved multiple joints(106/106,100%),and the young group involved less joints(15/102,14.71%).The difference was significant(P<0.05);9.The middle-aged and elderly group had more gout Stone(106/106,100%),and the young group had less combined tophi(21/102,20.59%).The difference was significant(P<0.05).10.The middle-aged and elderly group had more hypertension(72/106,67.92)%).The young group had less hypertension(19/102,18.63%).The difference was significant(P<0.05).11.The middle-aged and elderly group had more diabetes(66/106,62.26%).The young group(13/102,12.75%)were less complicated with diabetes.The difference was significant(P<0.05).12.The hemoglobin and serum uric acid in the young and middle-aged and elderly group patients were higher than the normal level(P>0.05).13.The rate of misdiagnosis in the young group(9/102,8.82%)was higher than that in the middle-aged and elderly group(2/106,1.89%).14.The recurrence rate after surgery(12/72,16.67%)was significantly lower than the that after conservative treatment(125/136,91.91 %).Conclusion 1.The age of onset of gouty arthritis is declined.2.Gouty arthritis is more common in males and postmenopausal women.3.There were differences in Tibetan-Chinese distribution,predisposition,BMI distribution,involvement of multiple joints,merger of tophi,hypertension,and diabetes.4.In the high altitude environment,gouty arthritis was accompanied by an increase in hemoglobin,with youth as the target.5.There was a certain misdiagnosis rate for gouty arthritis in the highland environment.Young people are the most common.6.The recurrence rate after surgical treatment is significantly lower than that after conservative treatment. |
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