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PubMed1990

[The effect of benzbromarone on hyperlipidemia in gout].

It is well known that triglycerides and cholesterol are often increased in gout. In 50% of the patients with hyperuricemia and in 40% of the patients with gout hyperlipidemia is found. K. Kŭnev has found in his former studies that the treatment with the drug Desuric leads to a decrease of cholesterol and other lipids in the blood. The follow up of 38 men with proved gout, mean age 45 years and mean duration of the disease 5 years, established an increase mainly of endogenous triglycerides and cholesterol. Benzbromarone treatment, 50-100 mg daily, led to a parallel decrease of serum lipids and uric acid. This allows benzbromarone to be recommended for the treatment of hyperlipidemia in gout which will lead to a decrease of the vascular complications and mortality in gout.

Adult↗
PubMed1977

[Gout in the age (author's transl)].

The importance of the gout is growing in the GDR as its frequency has been increasing since the sixties. The gout is a disease of metabolism with the following accompanying phenomena: renal lesion in gout, hypertension, cardiac diseases and peripheral arterial diseases. Besides, there are proved relations between hyperuricemia and obesity, hyperlipoproteinemia, diabetes mellitus as well as steatosis hepatis. In describing the nature of the gout the peculiarities of age are stressed. The treatment of the gout depends on the clinical state.

Age Factors↗
PubMed1984

A case-control study of alcohol consumption and drinking behaviour in patients with acute gout.

The alcohol intake and drinking behaviour of 24 patients who presented with acute gout in a family practice over a 5-year period were compared with these features of a control population matched for sex, age, weight and use of hyperuricemia-inducing diuretics. The average weekly alcohol intake of the group with gout was twice that of the control group (p less than 0.02), and a statistically significant relation was found between alcohol abuse and acute gout (p less than 0.05). About half of the patients with gout drank excessively. Acute gout should be considered a possible clinical sign of alcohol abuse.

Acute Disease↗
PubMedDate not supplied

Tophaceous gout in patients with systemic lupus erythematosus.

Coexistent gout and systemic lupus erythematosus (SLE) has been reported rarely, below the expected incidence even when adjusted for the discordance of age and sex of the affected populations. It is possible that SLE prevents expression of gout, or vice-versa. Review of the reported cases suggests that SLE is likely to be inactive and serum complement normal when gout is active. Lack of awareness of the possibility of gout and concurrent treatment with corticosteroids and nonsteroidal anti-inflammatory drugs may prevent recognition of gout in many patients with SLE.

Adult↗
PubMed1981

[Between hallux rigidus arthrosis and gout is no causal relationship].

The following assertion - continuously being alleged - is examined: Hallux rigidus arthrosis is said to occur in patients suffering from gout more frequently than average, and it should be valued as a symptom of chronic gout. Results of our own findings are as follows: 1. Hallux rigidus arthrosis becomes manifest in general on the right side or bilaterally, respectively; on the left side, however, it occurs rarely in an isolated state. 2. In patients with hallux rigidus arthrosis hyperuricaemia, gout, and obesity are seen more frequently than in adults of the normal population - these three diseases often are combined with static mutations in the region of the lower extremities. 3. No criteria can be stated as to causal relationship between hyperuricaemia (or gout) and hallux rigidus arthrosis. Obesity has to be considered a connecting link between both of them, and it is accelerating their genesis. 4. Hallux rigidus arthrosis represents - same as the arthrosis of Heberden - the more frequent possibility for confusing it with gout.

Adult↗
PubMed1993

Gout and pseudogout in hospitalized patients.

BACKGROUND: We determined the clinical characteristics of acute gout and pseudogout in hospitalized patients and examined the morbidity of inappropriate treatment and misdirected investigation when the diagnosis of acute crystal-induced synovitis was delayed. PATIENTS AND METHODS: We reviewed the medical records of 67 hospitalized adults seen in consultation consecutively by one hospital-based rheumatologist during a 64-month period between 1986 and 1991 with the diagnosis of acute gout or pseudogout. RESULTS: Gout was diagnosed in 41 patients, pseudogout in 24, and both crystal-induced diseases in two. The average age was 75.3 years. Polyarticular disease was common in both gout (49%) and pseudogout (42%). Fever attributable to synovitis was present in 34% of the patients and was more prevalent in patients with polyarticular (50%) than monoarticular (20%) inflammation. A quarter of the patients encountered errors in diagnosis, treatment, or both before rheumatologic consultation. Eleven patients experienced delays in diagnosis, and six patients had the correct diagnosis but received ineffective treatment. CONCLUSIONS: Fever and polyarticular arthritis are noteworthy features in the hospitalized patient with acute gout or pseudogout. When the diagnosis of crystal-induced synovitis is overlooked, misdirected investigation and inappropriate treatment compound the morbidity of continued pain.

Adult↗
PubMed1993

Tophaceous gout in patients with renal transplants treated with cyclosporine A.

Hyperuricemia and gout have been associated with cyclosporine A (CyA) therapy in transplant recipients. We describe 4 patients who developed severe tophaceous gout after renal transplantation. All of the patients received CyA, prednisone, and diuretic therapy. Three had episodes of allograft rejection. No patient had the diagnosis of gout before transplantation. All developed tophi within 5 years of the first attack of gout. Management of these patients has been difficult due to renal insufficiency, drug interactions and toxicity. Clinicians should be aware that tophaceous gout can occur rapidly in CyA treated transplant recipients.

Adult↗
PubMed2006

Gout and the risk of acute myocardial infarction.

OBJECTIVE: To determine if hyperuricemia and gouty arthritis are independent risk factors for acute myocardial infarction (MI) and, if so, whether they are independent of renal function, diuretic use, metabolic syndrome, and other established risk factors. METHODS: We performed multivariable logistic and instrumental variable probit regressions on data from the Multiple Risk Factor Intervention Trial (MRFIT). RESULTS: Overall, there were 12,866 men in the MRFIT who were followed up for a mean of 6.5 years. There were 118 events of acute MI in the group with gout (10.5%) and 990 events in the group without gout (8.43%; P = 0.018). Hyperuricemia was an independent risk factor for acute MI in the multivariable regression models, with an odds ratio (OR) of 1.11 (95% confidence interval [95% CI] 1.08-1.15, P < 0.001). In multivariable regressions in which the above risk factors were used as covariates, gout was found to be associated with a higher risk of acute MI (OR 1.26 [95% CI 1.14-1.40], P < 0.001). Subgroup analyses showed that a relationship between gout and the risk of acute MI was present among nonusers of alcohol, diuretics, or aspirin and among those who did not have metabolic syndrome, diabetes mellitus, or obesity. In separate analyses, a relationship between gout and the risk of acute MI was evident among those with and without those hyperuricemia. CONCLUSION: The independent risk relationship between hyperuricemia and acute MI is confirmed. Gouty arthritis is associated with an excess risk of acute MI, and this is not explained by its well-known links with renal function, metabolic syndrome, diuretic use, and traditional cardiovascular risk factors.

Arthritis, Gouty↗
PubMed1996

Nodal osteoarthritis and gout: a report of four new cases.

Recently gout has been recognized as a cause of inflammation in patients with nodal osteoarthritis. We reviewed the clinical data and radiographs of four patients with known osteoarthritis of the interphalangeal joints of the hands who developed gout. Radiographic changes of osteoarthritis in the affected interphalangeal joint were present in all four patients. In our cases, radiographic findings were typical of gout in one patient, including the presence of large eccentric soft tissue masses and periarticular erosions. In three patients, radiographic findings were non-specific, including only a small eccentric nodule in one patient, diffuse soft tissue swelling in a second, and a large calcified soft tissue mass with bony erosions in a third. Whenever a patient with inter-phalangeal joint osteoarthritis presents with an acute episode of inflammation the possibility of gout should be considered. Recognition of gout will allow the timely initiation of appropriate therapy.

Aged↗
PubMedDate not supplied

Advances in the management of gout and hyperuricaemia.

An acute attack of gouty arthritis is one of the most painful experiences reported throughout medical history. Therefore it is paramount to initiate appropriate therapy quickly in order to terminate the acute phase. This goal can be achieved with non-steroidal anti-inflammatory agents, colchicine, or corticosteroid-based therapies. Rarely, because of contraindications to these agents, only symptomatic treatment can be given until the attack subsides. The next step is to lower the serum urate level below the limit of solubility (i.e., below 40.8 mmol/L, or 6.8mg/dL) which reduces recurrences and begins to return the total body urate pool to normal. This equally important goal can be achieved by uricosuric agents or xanthine oxidase inhibitors, although the latter is generally favored. Allopurinol is the agent most commonly preferred because of its safety profile and ease of use, but there are known serious allergic reactions and untoward side effects that occasionally require discontinuation. Febuxostat, a xanthine oxidase inhibitor, and pegylated uricase are new agents under development and may be beneficial in these situations or when other comorbid conditions prevent the use of conventional treatments. Alcohol and dietary consumption are also related to hyperuricemia and acute gout. Recently beer, wine, and liquor were studied and the risk of gout varied according to the alcohol ingested. Furthermore, recent data sheds light on important dietary modifications that may help in the treatment of gout, and dispels certain beliefs about protein ingestion and the occurrence of acute gout. As we learn more about the associated conditions of hypertriglyceridemia, hypertension, and the metabolic syndrome, it may allow the tailoring of medical regimens that directly prevent or reduce recurrent attacks of gouty arthritis. There are specific approved treatments for these common comorbidities that have parallel effects of lowering serum urate levels. These recent findings may be especially important for treating refractory cases. While patient education remains a cornerstone to ensure compliance, other quality indicators for the management of this disease have been reported and should guide the clinician in the treatment of gout and result in improved care.

Adrenal Cortex Hormones↗
PubMed2001

Gout-induced arthropathy after total knee arthroplasty: a report of two cases.

Gout, although relatively rare in joint replacements, can present as an acute or chronic painful knee or hip arthroplasty. Gout and acute infection of a joint replacement can be difficult to differentiate, with the physical examination and laboratory study results frequently being similar. Both conditions can present with a rapid onset of joint pain, swelling, erythema, and constitutional symptoms, including fevers and malaise. Laboratory findings in both conditions often include an elevated leukocyte count, erythrocyte sedimentation rate, and C-reactive protein level. Negatively birefringent, needle-shaped crystals in the synovial fluid confirm the diagnosis of gout. The mistaken diagnosis of septic arthritis in a joint replacement with crystal-induced synovitis can lead to inappropriate open debridement or component removal. The current study includes a review of the literature and presents two cases of gout after total knee arthroplasty. These cases suggest that in situations of suspected sepsis without synovial fluid crystals, operative intervention is indicated with a presumed diagnosis of septic arthritis. The identification of chalky white or yellow deposits in the synovium or bone is highly suggestive of gout. The definitive diagnosis is made by polarized light histologic evaluation of these tissues. If these deposits are present in the absence of a positive preoperative culture, positive Gram stain for bacteria, or component loosening, component retention is indicated.

Aged↗
PubMed1995

Postsurgical gout.

Although catabolic events are known to precipitate gout, postsurgical gout has rarely been reported. We identified the charts of 302 patients treated over a 10-year period in a university center who carried the diagnosis of gout and who also had a surgical procedure. Fifty-two patients (42 male, 10 female) were found to have had a postsurgical episode of gouty arthritis. Ages ranged from 20 to 82 years (mean 60.1 +/- 2.1). Forty-five patients had a history of gout, 22 of whom were receiving medication and 23 who were not receiving chronic therapy. In seven patients the postsurgical event was their first attack. Attacks occurred 1-17 days (mean 4.2 +/- 0.5 [SE]) after surgical admission. Most attacks were in the lower extremity, but classic podagra was uncommon. Essentially all patients were febrile (100.7 +/- 0.2 degrees F) compared with admission (99.0 +/- 0.1 degree) (P < 0.001). There was a trend toward leukocytosis in the group as a whole, but the relationship of leukocytosis to the gout attack was most clearly seen in patients admitted for noninflammatory conditions (9.4 +/- 0.7 versus 12.8 +/- 0.8 x 1000 WBC/mm3, P < 0.001). Uric acid levels were elevated but did not follow the course of the attack. Most patients underwent a variety of tests and consultative evaluations because of their undiagnosed febrile episode. Once the diagnosis was established, all patients responded quickly to nonsteroidal anti-inflammatory drugs or colchicine. Despite evidence of a significant inflammatory response, no patient proved to have a suppurative focus as the source of their febrile episode.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

Gout attacks in chronic alcoholics occur at lower serum urate levels than in nonalcoholics.

OBJECTIVE: To determine if patients with gout with chronic alcoholism have lower serum urate levels than nonalcoholic patients. METHODS: Of 95 consecutive consults for acute gout at a VA medical center, 42 were excluded from study due to lack of crystal documentation, lack of urate value within 2 years, or treatment with allopurinol or probenecid. The remaining 53 patients were grouped by alcohol use and a retrospective chart review was done for these patients. RESULTS: Mean intercritical serum urate values for chronic alcoholics and nonalcoholics were similar at 9.7 +/- 2.1 for alcoholics and 9.5 +/- 2.1 for nonalcoholics. Yet, despite these similar intercritical serum urate values, and despite no difference between chronic alcoholics and nonalcoholics in frequency or severity of acute gout flares, patients with chronic alcoholism had index serum urate levels which were significantly lower than those of nonalcoholics. These mean index values, with standard deviations, were 7.7 +/- 1.3 for 15 chronic alcoholics and 10.1 +/- 1.3 for 34 nonalcoholics; p < 0.01). CONCLUSION: Alcoholics and nonalcoholics had comparable intercritical values. However, on presentation with acute arthritis, the index serum urate values for alcoholics were lower than in nonalcoholics. Values for serum urate below 8.5 mg/dl are of less value in excluding gout in chronic alcoholics than in nonalcoholics presenting with acute gout flares.

Aged↗
PubMed1997

[Radiologic findings in gout].

Radiological gout manifestations are detectable in the early stage, but also especially in the chronic stage of gout. Whereas in the early stage only soft tissue mutations (bursitis inflammation) and light calcium deposits are usually discernible, chronic gout leads to asymmetrical, diverse forms of osseous destruction, favouring smaller joints, but also affecting larger ones, which are caused by the intra-articular and extra-articular deposit of tophus material, corresponding to the progression and degree of severity of the illness. Radiologically-detectable changes in other organs, such as the kidneys, will be addressed. The high number of, and to some extent very characteristic, osseous mutations are compared with those mutations which are very similar to the diagnoses of other syndromes affecting the joints. Specifically, problems in differentiating diagnosis of rheumatoid arthritis, arthritis psoriatica, chondrocalcinosis, and other diseases of the joints will receive special mention. Reference is also made to the extreme diagnostic difficulties resulting from the rare but nevertheless conceivable influence of gout on the spine or sacroiliac joints. The method of magnetic resonance imaging for gout shows a characteristic signal behaviour of the tophus material. It has been determined that, through magnetic resonance tomography, interosseous tophi can be detected earlier and in a more widespread manner than with the aid of native X-ray images, such that an increase in the use of this method is to be expected.

Arthritis, Gouty↗
PubMed2002

Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout.

OBJECTIVE: The optimal serum urate levels necessary for elimination of tissue deposits of monosodium urate in patients with chronic gout is controversial. This observational, prospective study evaluates the relationship between serum urate levels during therapy and the velocity of reduction of tophi in patients with chronic tophaceous gout. METHOD: Sixty-three patients with crystal-confirmed tophaceous gout were treated with allopurinol, benzbromarone, or combined therapy to achieve serum uric acid levels less than the threshold for saturation of urate in tissues. The tophi targeted for evaluation during followup were the largest in diameter found during physical examination. RESULTS: Patients taking benzbromarone alone or combined allopurinol and benzbromarone therapy achieved faster velocity of reduction of tophi than patients taking allopurinol alone. The velocity of tophi reduction was linearly related to the mean serum urate level during therapy. The lower the serum urate levels, the faster the velocity of tophi reduction. CONCLUSION: Serum urate levels should be lowered enough to promote dissolution of urate deposits in patients with tophaceous gout. Allopurinol and benzbromarone are equally effective when optimal serum urate levels are achieved during therapy. Combined therapy may be useful in patients who do not show enough reduction in serum urate levels with single-drug therapy.

Adult↗
PubMed2001

Difficult gout and new approaches for control of hyperuricemia in the allopurinol-allergic patient.

A major obstacle to the treatment of hyperuricemia in patients allergic to allopurinol is the limited availability of suitable, equally effective, alternative, urate-lowering drugs. Conventional uricosuric drugs, including probenecid and sulfinpyrazone, are recommended for allopurinol- intolerant patients with gout and "underexcretion" hyperuricemia who have normal renal function and no history of nephrolithiasis. Therapeutic options in those in whom traditional uricosuric drugs are contraindicated, ineffective, or poorly tolerated include slow oral desensitization to allopurinol and cautious administration of oxipurinol. Allopurinol desensitization is useful particularly in those who have failed other treatment modalities. If available (as in Europe, South Africa, and Japan), benzbromarone may be tried in patients with gout and mild-to-moderate renal insufficiency. Recombinant urate oxidase can be used in the short-term prophylaxis and treatment of chemotherapy- associated hyperuricemia in patients with lymphoproliferative and myeloproliferative disorders. Hyperuricemia and gout occur with increased frequency in cyclosporine-treated allograft transplant recipients. The management of gout in these patients is complicated by two main factors: cyclosporine-induced renal impairment, and interactions with medications used to preserve the allograft.

Allopurinol↗
PubMedDate not supplied

Metabolic diseases: gout.

Gout is a disease of antiquity but is increasing once again in prevalence despite availability of reasonably effective treatments. This may be related to a combination of factors, including diet, obesity, and diuretic use. Allergic reactions, noncompliance, drug interactions, and sometimes inefficacy all limit the effective use of current hypouricemic agents. There are new treatments for gout on the horizon, including febuxostat, a nonpurine inhibitor of xanthine oxidase with a potentially better combination of efficacy and side effects than allopurinol. Diagnostic progress is being made in that ultrasound may offer a noninvasive means of diagnosing tophaceous deposits in and around joints. The increasing prevalence of gout means that dermatologists will see more cutaneous manifestations of gout, including tophi, draining sinus tracts, panniculitis, and dystrophic calcifications.

Gout↗
PubMed1998

Decreased serum concentrations of 1,25(OH)2-vitamin D3 in patients with gout.

We measured serum concentrations of 1,25(OH)2-vitamin D3, 25(OH)-vitamin D3, parathyroid hormone (PTH), and uric acid in 114 male patients with primary gout and 51 normal male control subjects. Serum 1,25(OH)2-vitamin D3 was significantly lower in patients with gout compared with control subjects (38.4 +/- 11.9 v 44.4 +/- 11.0 pg/mL, P < .005), whereas no differences were observed between the two groups for serum 25(OH)-vitamin D3 or PTH. Serum uric acid was significantly higher in patients with gout versus control subjects (8.8 +/- 1.3 v 5.7 +/- 1.0 mg/dL, P < .0001). In addition, there was a significant negative correlation between serum uric acid and 1,25(OH)2-vitamin D3 concentrations (r = .17, P < .05). Administration of allopurinol or benzbromarone to the patients for 1 year caused a significant increase in serum 1,25(OH)2-vitamin D3, which was associated with a significant decrease in serum uric acid. In contrast, serum concentrations of 25(OH)-vitamin D3 and PTH were not affected by these drugs. These results suggest that uric acid per se may directly decrease serum 1,25(OH)2-vitamin D3 in patients with gout by inhibiting 1alpha-hydroxylase activity.

Adult↗