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PubMed2001

Hyperuricemia, gout, and renal function after liver transplantation.

BACKGROUND: Hyperuricemia is a recognized complication of renal and cardiac transplantation, but the development of hyperuricemia and gout following liver transplantation have received less attention. We have retrospectively assessed the prevalence of hyperuricemia in 134 consecutive liver transplant recipients. RESULTS: Forty-seven percent of the liver transplant recipients studied had hyperuricemia. Serum creatinine was higher in hyperuricemic than in nonhyperuricemic patients. Peak uric acid correlated significantly with corresponding serum creatinine (rs=0.694). Only 6% developed gout. All the patients with gout and 10 hyperuricemic patients with renal impairment but without gout were treated with allopurinol. Over a median period of 3 months, mean serum creatinine fell from 177 micromol/l to 160 micromol/l (P=0.01), without change in type or dose of immuno-suppression. CONCLUSIONS: There is an important association between liver transplantation and hyperuricemia. Treatment with allopurinol results in a significant reduction in serum creatinine in patients with gout and in those with hyperuricemia and renal impairment.

Adult↗
PubMed2001

Tacrolimus for the treatment of gout in renal transplantation: two case reports and review of the literature.

Episodes of gout are common in the setting of renal transplantation. Hyperuricemia and gout have been associated with the use of the calcineurin inhibitor, cyclosporine. We report two cases of severe polyarticular gout resistant to conventional therapy in renal transplant recipients that resolved after switching from cyclosporine to tacrolimus-based immunosuppression. There was no alteration in renal function, and trough concentrations of both cyclosporine and tacrolimus were within the recommended range. Resolution of gout occurred within a month of discontinuation of cyclosporine and commencement of tacrolimus. Use of tacrolimus may be beneficial in the renal transplant recipient with refractory gout.

Adult↗
PubMed2004

Contribution of polymorphisms in the apolipoprotein AI-CIII-AIV cluster to hyperlipidaemia in patients with gout.

BACKGROUND: Studies have shown that hyperuricaemia is independently related to the insulin resistance syndrome and that polymorphisms of the apolipoprotein AI-CIII-AIV cluster are also related to insulin resistance. OBJECTIVE: To study the prevalence of polymorphisms of the apolipoprotein AI-CIII-AIV cluster in persons with gout and to determine whether these polymorphisms contribute to the pathophysiology of gout or to altered lipid concentrations. METHODS: Plasma cholesterol, triglycerides, uric acid, VLDL, LDL, IDL, and HDL triglycerides, cholesterol, and the renal excretion of uric acid were measured in 68 patients with gout with gout and 165 healthy subjects. Polymorphisms were studied by amplification and RFLP in all subjects, using XmnI and MspI in the apolipoprotein AI gene and SstI in the apolipoprotein CIII gene. RESULTS: The A allele at position -75 bp in the apolipoprotein AI gene was more common in patients with gout than in controls (p = 0.01). Levels of cholesterol, triglycerides, uric acid, basal glycaemia, and HDL cholesterol were higher in the patients (p<0.001). In the patients there was also an interaction between mutations at the two polymorphic loci studied in the apolipoprotein AI gene (p = 0.04). An absence of the mutation at position -75 bp of the apolipoprotein AI gene resulted in increased plasma triglyceride levels. CONCLUSIONS: Gouty patients have an altered allelic distribution in the apolipoprotein AI-CIII-AIV cluster, which could lead to changes in levels of lipoproteins. This is not caused by a single mutation but rather by a combination of different mutations.

Adult↗
PubMed1983

Vascular mortality in patients with gout and in their families.

A mortality study was performed to determine death rates from coronary and cerebrovascular pathology in 180 patients with gout and their families. Lipid profiles were also analysed. Neither male nor female gout patients after presentation to hospital nor their male or female first-degree relatives were found to have an increased risk of dying from coronary artery or cerebrovascular disease. Families of hyperlipidaemic gout patients had a slightly increased incidence among males of death from coronary artery disease, a finding which may reflect the hypercholesterolaemia found among these relatives. It could have influenced the vascular mortality rate in families of hyperlipidaemic gout patients without any relationship to the diagnosis of gout itself.

Adult↗
PubMed1984

Gout in South African blacks.

A retrospective study was carried out to determine the frequency, age of onset, mode of presentation, pattern of joint involvement, and incidence of primary and secondary gout in black patients with gout who were admitted to the King Edward VIII Hospital in Durban, South Africa. Nineteen patients were admitted to hospital with gout over a 5-year period from 1977 to 1981. The admission rate was found to be 4.7/100 000 hospital admissions. Five patients (26%) presented with monoarthritis and 14 patients (74%) had polyarthritis on admission. The joints most frequently involved were the knees (74%), the first metatarsophalangeal (MTP) joint (58%), and ankles (42%). The serum uric acid (SUA) was increased in 94%, and tophi were noted clinically in 47%. Eight patients (42%) with hypertension were on treatment with diuretics and 7 of these patients had a raised blood urea. These 8 patients (42%) were considered to have secondary gout, while no secondary causes were noted in the remaining 11 patients (58%) who had primary gout.

Adult↗
PubMed1992

Diuretic induced gout: a multifactorial condition.

Fifteen patients with clinical gout occurring after long term treatment with diuretics were studied retrospectively. In all 15 patients one or more additional factors were present which might have contributed to the hyperuricaemia and gout. The most common of these was the impairment of the glomerular filtration rate. Twenty five other patients receiving long term treatment with diuretics who did not have gout were also studied. The concentrations of uric acid, urea, and creatinine were, in general, markedly lower in these patients than in those who had developed gout. It is concluded that diuretic induced gout occurs in patients in whom there is an additional cause of hyperuricaemia, usually impaired renal function.

Aged↗
PubMed1987

Migration and gout: the Tokelau Island migrant study.

The prevalence and 14 year incidence of clinical gout and its precursors were investigated in the Polynesian population of Tokelauans living in the Pacific basin, non-migrant Tokelauans living in their isolated atoll homeland being compared with migrant Tokelauans living in urban New Zealand. The age standardised prevalence of gout in Tokelauan men in New Zealand was higher than that in non-migrant Tokelauan men, being 21.0 and 19.5/1000 subjects at the beginning of the study and 51.0 and 14.6/1000 at the end of study, respectively. Migrant men in New Zealand aged under 55 had higher mean serum uric acid concentrations than non-migrant men of the same age. The prevalence of gout was low in women in both environments. The age standardised relative risk of developing gout between 1968 and 1982 was 9.0 times higher in the migrant men than in the non-migrant men. Age, serum uric acid concentration, serum cholesterol concentration, and self reported alcohol consumption at entry to the study were the best set of predictors of gout in men. Preventive strategies to change body mass, diet, and patterns of alcohol use need to be developed in this population.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration of tophi for crystal identification in problematic cases of gout. A report of two cases.

BACKGROUND: The definitive diagnosis of gout is best established by demonstration of monosodium urate (MSU) crystals in the synovial fluid or biopsy. Fine needle aspiration cytology (FNAC) of tophi can play a crucial role in diagnosis. CASES: A 36-year-old chronic alcoholic male developed subcutaneous nodules on both malleoli without a history of arthropathy and with normal serum uric acid levels. FNAC of the nodules demonstrated stacks and sheaves of needle-shaped crystals of MSU. A 50-year-old diabetic male developed multiple nodules on the feet. He gave a past history of painful athropathy. A roentgenogram of the feet was suspicious for gout; however, joint aspiration failed, and the serum uric acid levels were normal. At this juncture FNAC of the feet tophi clinched the diagnosis of gout. In both cases, polarization of needle washings (wet mount) and the fixed, Papanicolaoustained smears showed negatively birefringent, needle-shaped crystals of MSU, thus confirming the diagnosis of gout. CONCLUSION: FNAC of gouty tophi is an easy alternative to synovial biopsy and joint fluid analysis. It is simpler, easier and less painful. As crystals are preserved in stained smears, they can be employed for polarization and confirmation of gout.

Adult↗
PubMed2006

A concise history of gout and hyperuricemia and their treatment.

First identified by the Egyptians in 2640 BC, podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century BC, who referred to it as 'the unwalkable disease'. The term is derived from the Latin word gutta (or 'drop'), and referred to the prevailing medieval belief that an excess of one of the four 'humors'--which in equilibrium were thought to maintain health--would, under certain circumstances, 'drop' or flow into a joint, causing pain and inflammation. Throughout history, gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that, at least in the past, could only be afforded by the affluent, gout has been referred to as the 'disease of kings'. Although there is evidence that colchicine, an alkaloid derived from the autumn crocus (Colchicum autumnale), was used as a powerful purgative in ancient Greece more than 2000 years ago, its first use as a selective and specific treatment for gout is attributed to the Byzantine Christian physician Alexander of Tralles in the sixth century AD. Uricosuric agents were first used at the end of the 19th century. In the modern era, nonsteroidal anti-inflammatory drugs are usually the drugs of choice for treating acute gout. Perhaps the most important historical advance in the treatment of hyperuricemia was the development of xanthine oxidase inhibitors, which are effective in reducing plasma and urinary urate levels and have been shown to reverse the development of tophaceous deposits.

Arthritis, Gouty↗
PubMed1980

Hereditary uricemia and articular gout in chickens.

Ten generations of selection for uricemia and articular gout have led to the development of the HUA line which is characterized by a threefold increase in plasma level of uric acid when compared to the control LUA line, even when fed diets containing normal levels of protein. Articular gout results in many cases, especially among adult males fed a normal breeder diet. Restriction protein level of the diet delays or prevents the development of articular gout in mature males of the HUA line. The data suggest that relatively few genes are responsible for the defect in renal transport of uric acid which underlies the uricemia and gout. The association of lower levels of uric acid with dominant white plumage color suggests a linkage of a major recessive gene for the I gene. Ambient temperature, because of its effect on food consumption, influences the level of uric acid in blood plasma. The HUA line and its control (LUA line), both sex-linked dwarfs, would appear to provide an excellent animal model for the experimental study of gout in man.

Animals↗
PubMed2004

Carpal tunnel syndrome due to tophaceous gout.

Tophaceous gout is a recognized cause of carpal tunnel syndrome. Of 2649 carpal tunnel releases, 15 hands in 13 patients were identified with tophaceous gout in the carpal tunnel. The incidence of tophaceous gout in the carpal tunnel was 0.6%. Twelve of 13 patients were male, and 8 of 10 patients with a history of gout developed carpal tunnel syndrome despite adequate medical treatment. Thus, consideration should be given for tophi as a cause of carpal tunnel syndrome, especially in older men despite medical treatment for gout.

Carpal Tunnel Syndrome↗
PubMed1999

Gout and hyperuricemia.

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The peak incidence occurs in patients 30 to 50 years old, and the condition is much more common in men than in women. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. Acute gout most commonly affects the first metatarsal joint of the foot, but other joints are also commonly involved. Definitive diagnosis requires joint aspiration with demonstration of birefringent crystals in the synovial fluid under a polarized light microscope. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroids and analgesics. In patients without complications, NSAID therapy is preferred.

Acute Disease↗
PubMed2000

Risk factors for gout in Togolese patients.

OBJECTIVE: To determine the risk factors for gout in Togolese patients. METHODS: The medical records of patients admitted to the Lomé Teaching Hospital (Togo) rheumatology department over a ten-year period were reviewed retrospectively. RESULTS: Of the 8351 study patients, 160 (1.9%) fulfilled American Rheumatism Association criteria for gout; 159 were male. Mean age at disease onset was 44 years, and mean disease duration was six years. Tophi were recorded in 35 cases and a history of renal colic in one. Only five patients (3.1%) had no identifiable risk factors. The main risk factors in the remaining patients were alcohol abuse (133/160, 83.12%), overweight/obesity (64/160, 40%), and hypertension (42/160, 26.25%); 153 patients (95.6%) had at least one of these risk factors, 58 patients (36.32%) had two, and 14 (8.8%) had all three. Of the 42 hypertensive patients, 20 were on diuretic therapy. Seventeen patients (10.62%) had a family history of gout. There was no evidence that AS or AC hemoglobinopathy (32 and 13 cases, respectively) influenced the course or natural history of gout. CONCLUSION: Although population-based studies are needed for confirmation, our study suggests that risk factors for gout in Togolese patients are similar to those in other parts of Africa and in Western countries.

Adult↗
PubMedDate not supplied

[Gout in the past and uric arthritis today in Croatia] ].

In the past, gout was well known in these places, from Istria to Dubrovnik. Our very first dictionaries also witness about gout. Old doctors from Krapinske Toplice had also written about gout. Dr Edmund Mai, in his article published in "Lijecnicki vjesnik" in 1904 mentions "171 cases of uric arthritis". But, after that, for long 60 years there wasn't even a word about our patients, except surprise on very high incidence of the disease in the past. Even our handbooks had claimed that uric arthritis is not common in our country. In 1964 after 60 years of silence, the first article about our patients with uric arthritis, was published in "Lijecnicki vjesnik". These patients were medically treated for average of 13 years, and still were misdiagnosed. After that article, the numbers of patients with gout and articles on uric arthritis permanently rise. Today, the incidence of gout in Croatia is similar to that in other European countries.

Arthritis, Gouty↗
PubMed2003

Patient compliance in rheumatoid arthritis, polymyalgia rheumatica, and gout.

OBJECTIVE: (1) To explore patient compliance with prescribed drug regimens in the setting of usual care for outpatients with rheumatoid arthritis (RA), gout, and polymyalgia rheumatica (PMR) by utilizing electronic medication event monitors (MEMS(R)) to register openings of the medication package. (2) To examine the influence of disease, frequency of intake of the drug, and class of drug on compliance. (3) To explore the influence of demographic factors, quality of life measures, coping, health status, and functional ability as potential predictors of patient compliance. METHODS: A total of 127 consenting consecutive patients were enrolled: 81 patients with RA, 33 taking nonsteroidal antiinflammatory drugs (13 diclofenac TID and 20 naproxen BID) and 48 taking disease modifying antirheumatic drugs [25 sulfasalazine (SSZ) BID and 23 methotrexate (MTX) once weekly]; 17 patients with PMR starting with prednisolone QD; and 29 patients with gout starting with colchicine (12, QD) or starting with uric acid lowering agents (17, QD). All patients received first prescriptions and were instructed to take the medication as prescribed. Followup was 6 months (gout 12 mo). All patients were aware of the monitoring capability of the package. At baseline a series of questionnaires was completed. We summarized the dosing histories as "taking compliance" (percentage of total prescribed doses taken), "correct dosing" (percentage of doses taken as prescribed), and "timing compliance" (percentage of doses taken within +/- 25% of prescribed interdose intervals). RESULTS: A total of 26,685 days (> 73 patient-years) were monitored. Compliance expressed as "taking compliance," mean (95% CI), "correct dosing," mean (95% CI), and "timing compliance," mean (95% CI) are: naproxen: 82% (75-90), 68% (57-80), 48% (34-61); diclofenac: 77% (61-93), 67% (47-87), 39% (21-57); MTX: 107% (98-117), 81% (75-87), 83% (76-90); SSZ: 72% (60-84), 55% (44-67), 25% (18-33); prednisolone: 96% (89-102), 88% (83-92), 82% (74-89); colchicine: 65% (48-81), 44% (26-62), 32% (18-46); and uric acid lowering agents: 84% (76-92), 74% (63-85), 65% (52-79). Missed doses occurred more frequently than taking of extra doses: in RA, on 10% of all monitored days there was no evidence of dosing, while on 3% of all monitored days extra doses were taken. In PMR and gout these data are 10% and 4%, and 15% and 7%, respectively. We observed a decline of compliance over time in all study medication groups. Multiple regression analyses showed that the class of medication (symptom modifying or disease controlling), the dosing frequency, the patient's sex, coping pattern (avoidance, passive reaction pattern, and expression of emotions), and the overall health (total Nottingham Health Profile score) together explained 67% of the variance in taking compliance (adjusted R2) (p = 0.002). CONCLUSION: Studying patient compliance with prescribed drug regimens utilizing electronic medication event monitors in RA, gout, and PMR showed that large differences exist in compliance between the various medication groups. Compliance declines over time. A regression model shows that it is possible to relate differences in patient compliance to a number of medication and patient related factors.

Activities of Daily Living↗
PubMedDate not supplied

[Gout in Togolese patients].

A study was carried out to determine the frequency and semiological characteristics of gout in patients attending a hospital clinic in Lomé, Togo. Gout was diagnosed in 71 of the 1,821 patients seen from october 1989 through october 1991. Clinical findings and increased serum uric acid levels were the basis for the diagnosis of gout in 63 patients; in addition, in the eight other patients monosodium urate crystals were demonstrated in joint fluid. All gout patients were male and mean age at onset was 45 years. Mean duration of the disease was 8.5 years, Forty-seven patients had normal hemoglobin, whereas a hemoglobinopathy was present in the 24 other subjects (hemoglobin AS: 15 cases; hemoglobin AC: 7 cases; hemoglobin CC: 2 cases). Twenty-seven patients (38%) were obese and 24 (34%) had hypertension. Forty-six patients (65%) were habitual drinkers. Twenty patients (28%) had tophi. None of the patients had a history of renal colic. The other clinical features of the disease were similar to those seen in Western countries. Results of this study are in striking contradiction with the common belief that gout is exceedingly rare in black Africa.

Adult↗
PubMed2005

[Severity of a female gout course].

AIM: Comparison of a gout course in males and females. MATERIAL AND METHODS: The trial enrolled 34 patients (17 females and 17 males). The patients were matched by age and the disease duration. Severity of a gout course was assessed by the disease history, articular syndrome, concomitant diseases, blood biochemistry. Statistical processing was made with a computer program "Statistica 6.0". RESULTS: Events predisposing to purin metabolism disturbances and, therefore, to development of gout occur more frequently in females than in males. For the most part this concerns arterial hypertension and intake of diuretics. Women often have endocrine pathology (artificial menopause, dysmenorrhea, euthyroid goiter). In women gout runs a more severe course manifesting in early chronization, polyarticularity, lingering arthritis, rapid formation of tophuses. Both groups demonstrated marked polymorbidity with accumulation of the diseases related to atherosclerosis. Distinct group differences by content of uric acid seem to arise from early onset of chronic renal failure in women. CONCLUSION: In the absence of sex- and age-related differences, a more severe course of gout is observed in women. This may be due to hyperuricemia and a trend to the disease chronization, high prevalence of arterial hypertension and renal failure.

Arthritis↗
PubMed1991

[Epidemiological and clinical aspects of gout in equatorial Africa. Apropos of 60 cases followed in the Department of Rheumatology of the Teaching Hospital Center in Brazzaville].

Between December 15, 1988 and November 30, 1990, the application of Rome and New York criteria enabled the diagnosis of 60 cases of gout among patients with arthritis or hyperuricemia seen as out-patients or hospitalised in the Department of Rheumatology of the Brazzavile T.H.G. There were 57 men and 3 women, with a mean age of 51. Gout is the primary form of inflammatory arthropathy in adults in the Congo. Affecting all socio-professional groups, it is diversely associated with obesity, alcoholism, hypertension and diabetes. Initial involvement affects the big toe. Oligo and polyarticular forms predominate because of the absence or delay in specific treatment. This series included 30 per cent of cases of chronic gout. Evidence of renal impairment was found in one third of patients. However, urate lithiasis was absent. Tophi were found preferentially over the elbows. Sickle cell disease was responsible for one case of tophaceous gout. In contrast with the results of studies undertaken before the 1980s, gout is seen to be a common condition in equatorial Africa.

Adult↗