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PubMed1999

Synovial fluid analysis for diagnosis of intercritical gout.

BACKGROUND: The diagnosis of gout in the intercritical phase can be difficult. OBJECTIVE: To determine whether synovial fluid analysis allows the diagnosis of intercritical gout. DESIGN: Cross-sectional study. SETTING: Outpatient rheumatology clinics. PATIENTS: 101 patients with gout. INTERVENTION: Arthrocentesis of 80 knees and 21 first metatarsophalangeal joints (each joint from a different patient) that had been inflamed but were currently asymptomatic. MEASUREMENTS: Frequency with which arthrocentesis yielded synovial fluid; presence of monosodium urate crystals in the synovial fluid sample; and, for synovial fluid with crystals, the number of microscope fields that had to be scanned before crystals were found. RESULTS: Synovial fluid was obtained from 91 of 101 joints. The fluid from all 43 patients not receiving hypouricemic agents contained monosodium urate crystals. These crystals were found in the synovial fluid of only 34 of 48 patients receiving hypouricemic agents. In 90% of the synovial fluid samples that contained crystals, crystals were seen in the first five microscope fields examined. CONCLUSIONS: Arthrocentesis of asymptomatic knees and first metatarsophalangeal joints and synovial fluid analysis are simple procedures that facilitate the diagnosis of gout during intercritical periods.

Adult↗

PubMed1997

Gout and hypothyroidism.

A case of gout in a patient with primary hypothyroidism has been presented. Often missed as a companion of gout, hypothyroidism has a frequency of occurrence with gout that is significant and is probably a precipitating factor in these gouty attacks. The physician should be alert for signs and symptoms of this often occult disease in patients with hyperuricemia and gout.

Adult↗

PubMed1998

The epidemiology study of hyperuricemia and gout in a community population of Huangpu District in Shanghai.

OBJECTIVE: To investigate the prevalence of hyperuricemia and gout in a community population of Huangpu District in Shanghai. METHODS: In the target community, 2037 dwellers were interviewed with relevan questionnares from house to house. According to even house number 1017 blood samples were taken for serum uric acid (SUA) levels measured with the uricase-peroxidase enzymatic method. RESULTS: The prevalence of hyperuricemia was 14.2% in men (SUA > 70 mg/L, 62 cases), 7.1% in women (SUA > 60 mg/L, 41 cases), 10.1% in both sexes. Seven gout patients were all men. The prevalence of gout in 2037 dwellers in Huangpu District was 0.77% in men and 0.34% in both sexes. CONCLUSIONS: The mean SUA level in each age group in this survey was much higher than that of a previous study 1 carried out in Shanghai, Beijing and Guangzhou in 1980 (P < 0.05). And the prevalence of hyperuricemia was increased rapidly (in men: from 1.4% in the survey of 1980 to 14.2% in our survey; in women: from 1.3% in the survey of 1980 to 7.1% in our survey). Compared with Idonesia data in 1992, the prevalence of hyperuricemia and gout in our survey was lower than that in Indonesia (P < 0.05), which suggests that racial and genetic predispositions are key causative factors.

Adolescent↗

PubMed1999

Identification of a new single nucleotide substitution on the hypoxanthine-guanine phosphoribosyltransferase gene (HPRT(Tsou) from a Taiwanese aboriginal family with severe gout.

OBJECTIVE: A new single nucleotide change of the hypoxanthine-guanine phosphoribosyltransferase (HPRT) gene on coding region has been identified from a Taiwanese aboriginal family with gout. The mutation was used to screen 27 members of the family, 22 Tsou, 70 Atayal, and 76 Bunun children, the elders for whom had been found to have a high prevalence of gout. METHODS: An entire peptide of HPRT coding region was directly sequenced from the cDNA of a patient with severe gout, and by using polymerase chain reaction and restriction fragment length polymorphism to screen the other participants. RESULTS: A new nucleotide change located at nucleotide 152 (G to A transition) was found that predicted an arginine to glutamine substitution at amino acid 51. This variant was named HPRT(Tsou), and was found in 3 women and 3 men among the patient's 7 siblings, 2 boys and 2 girls among the 8 children of the siblings, and one female Tsou (4.5%, 1/22) and one female Atayal (1.4%, 1/70). The serum uric acid concentration among male HPRT(Tsou) carriers in the patient's family was significantly higher than among those who had at least one HPRT gene that did not have HPRT(Tsou). CONCLUSION: We found that the HPRT(Tsou) gene variant is partially responsible for the hyperuricemia in an aboriginal population in Taiwan known for a high incidence of gout.

Adolescent↗

PubMed2000

Monoarticular acromioclavicular joint gout: a case report.

Acromioclavicular joint gout is extremely rare. The case presented represents the first case of monoarticular acromioclavicular joint gout reported. It is also the first reported case of acromioclavicular joint gout in an immunosuppressed patient. The diagnostic pitfalls inherent in the evaluation of acute monoarticular arthritis in an immunosuppressed patient are illustrated. Furthermore, the case demonstrates one of the atypical presentations of gout that may occur in renal transplant patients taking cyclosporin A.

Acromioclavicular Joint↗

PubMed2001

[An epidemiological and clinical study of primary gout].

OBJECTIVE: To evaluate the prevalence of primary gout in Shantou and Beijing area, and understand it's clinical features. METHODS: Three epidemiological studies in Chenghai downtown, and the one of study in Beijing were studied. Clinical, laboratory and radiology data were collected and analyzed. RESULT: The prevalence of primary gout in Chenghai surveys was 0.17%, 0.15% and 0.26% respectively; no case of primary gout was found in Beijing survey. Among the patients, male to female ratio was 21:1; average onset age of females was significantly higher than that of males. The numbers of patient in the recent 10 years was increasing. At the first attack, the first metatarsophalangeal joint was involved among 79.7% of all cases; no fourth metatarsophalangeal joint involvement had been found. Hyperlipemia was the most common accompanying abnormal laboratory test (57.1%). Radiographic bone erosion was found in 49.4% patients, most of them, the duration of disease was over 5 years. CONCLUSION: The prevalence of primary gout was higher in Shantou area than that in Beijing, and it was increasing in the recent 10 years in Shantou area. The difference of geography, climate, food and lifestyle could be responsible for the different prevalence in different area.

Adult↗

PubMedDate not supplied

[Uncharacteristic symptoms of the motor apparatus in gout].

Gout may present in such atypical forms as "primary-chronic", "masked", or "asymptomatic gout at all stages affecting almost any joint. These uncharacteristic presentations were found in 22 out of 124 patients observed. The disease of 4 patients is described as casuistics. Important conclusions of practical use for early diagnosis and early treatment are drawn. Every arthropathy in a male where the diagnosis is not certain, must be suspected as being due to gout. The diagnosis can be assured by detecting urate deposits in the tissue. Determinations of the serum uric acid level can only be indicative since they are subject to a variety of influences. In early disease the x-ray appearances may be described as normal; in later disease as "degenerative" in the joints or in the vertebral column. In an acute relapse the colchicine-test is of high specifity, but its interpretation may be difficult in the primary chronic forms. The other clinical manifestations of the gout syndrome are of high value for the selection of patients in whom urate deposits in the tissue must be sought.

Adult↗

PubMed2003

Primary gout in Shantou: a clinical and epidemiological study.

OBJECTIVE: To evaluate the prevalence of primary gout in the Shantou area, China, and to understand its clinical features. METHODS: Samples from three surveys of the Chenghai across ten years were studied. Clinical, laboratory and radiology data of 419 cases of primary gout were collected and analyzed. RESULTS: Prevalence of primary gout in the three surveys were 0.17%, 0.15% and 0.26%, respectively. Among the clinical patients, the ratio of male to female was 21:1; the average age of onset of women was significantly higher than that of men. The number of cases in the last ten years has been increasing. In the first wave of cases, the first metatarsophalangeal joint was involved in 82.1% of all cases; no fourth metatarsophalangeal joint involvement had been observed. Hyperlipemia was the most common accompanying abnormal laboratory test (57.1%). Radiographic bone erosion was found in 49.4% patients, most of them with disease duration more than 5 years. CONCLUSIONS: The prevalence of primary gout in Shantou area has been increasing in the last ten years. Changes in diet and lifestyle may be responsible for this rapid increase.

Adult↗

PubMed2003

Acute gout precipitated by total parenteral nutrition.

Hypouricemia is seen in a variety of clinical situations. Although precipitation of gout is well known following initiation of uricosuric therapy, it has been reported rarely following the institution of total parenteral nutrition (TPN), despite its known uricosuric effect. We describe a patient who developed polyarticular gout on 2 occasions after a sudden decline in serum uric acid after initiation of purine-free TPN. Potential etiologies include increased urate clearance due to the infusion of glycine or amino acids. Monitoring of serum uric acid concentrations in patients with a history of gout may help predict a gout attack. Prophylactic treatment or alternative TPN formulations may be indicated.

Acute Disease↗

PubMed1992

Gout.

Gout is a common disease in the primary health care setting. Diagnosis of primary gout is definite if urate crystals are present in synovial fluid or tophi. The colchicine therapeutic trial is a useful diagnostic aid but not specific. Secondary gout is associated with myeloproliferative disease. Non-steroidal anti-inflammatory agents or colchicine are the main stays of treatment in acute gouty arthritis. In the inter-critical period, uricosuric agents or allopurinol can be used to control hyperuricaemia. Allopurinol is the treatment of choice in secondary gout. Asymptomatic hyperuricaemia is not an indication for therapy.

Adult↗

PubMed2003

Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study.

OBJECTIVE: To carry out a cross-sectional survey on prevalence of musculoskeletal symptoms, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. METHODS: In Shanghai, 4 communities comprising 7603 inhabitants over 15 years of age in an urban population were randomly selected from 13 communities. Interviews were conducted from September 1997 to March 1998 by trained physicians using the COPCORD Core Questionnaire. Physical and radiographic examinations and serologic tests were carried out when required to classify categories of rheumatic diseases. The diagnoses of RA, systemic lupus erythematosus (SLE), and gout were based on American Rheumatism Association criteria. The diagnosis of AS strictly followed the modified New York criteria of 1984. Crude prevalence rates were standardized according to a standard Chinese population for age and sex structure. RESULTS: A total of 6584 adults (3394 women, 3190 men) were interviewed, and response rate was 86.6%. The age and sex standardized prevalence rate of rheumatic symptoms at any site amounted to 13.3% (95% CI 12.5-14.1%). Symptoms occurred more frequently in the following sites: knee 7.0% (95% CI 6.4-7.6%), lower back 5.6% (95% CI 5.0-6.2%), shoulder 4.7% (95% CI 4.2-5.2%), and neck 2.4% (95% CI 2.0-2.8%). Women complained of rheumatic symptoms more frequently than men. The standardized rates of RA, AS, gout, symptomatic knee osteoarthritis, and soft tissue rheumatism were 0.28% (95% CI 0.15-0.41%), 0.11% (95% CI 0.03-0.19%), 0.22% (95% CI 0.11-0.33%), 4.1% (95% CI 3.6-4.6%), and 3.4% (95% CI 3.0-3.8%), respectively. Two cases of SLE, one case of dermatomyositis, and one case of systemic sclerosis were found. CONCLUSION: Compared with rates in European and Western countries the prevalence rates of RA, AS, and gout are low in Shanghai, China, although the prevalence rates of rheumatic symptoms are high.

Activities of Daily Living↗

PubMed1992

The epidemiology of gout and hyperuricemia in a rural population of Java.

The prevalence of gout and hyperuricemia was investigated by a survey of a total population of 4683 rural adults. The successful response rate was 95.2%. Of the respondents 85.3% of the individuals were examined. The prevalence of gout and hyperuricemia in men was 1.7 and 24.3%, respectively. The male to female ratio was 34:1 for gout and 2:1 for hyperuricemia. The observed higher prevalence of gout and hyperuricemia in this male Malayo-Polynesian population compared with Caucasian data, in spite of a lower life expectancy and subsistence economy, suggests that genetic and racial predisposition are key causative factors.

Adolescent↗

PubMed2005

[Effects of processing Phellodendron amurense with salt on anti-gout].

OBJECTIVE: To investigate the effects of processing Phellodendron anurene with salt on anti-gout. METHOD: The mouse serum uric acid level and liver xanthine oxidase activity were used to evaluate anti-gout effects of raw and processing P. amurense with salt. RESULT: Both raw and processing P. amurense with salt reduced serum uric acid levels in the in hyperuricemic mice, and inhibited activities of liver xanthine oxidase at the low and high doses respectively, thus exhibiting anti-gout effects. Moreover, they showed the tendency to decrease the uric acid levels in the normal animal only at the high dose. The latter was a little weaker than the former. CONCLUSION: Processing with salt might not significantly change anti-gout effect of P. amurense.

Animals↗

PubMed2005

[Markers of vascular endothelium activation in gout].

AIM: To determine clinical significance of laboratory markers of vascular endothelium activation in gout. MATERIAL AND METHODS: A total of 16 males aged 31-68 years with gout entered the study. The diagnosis satisfied Vallas' criteria, duration of the disease varied from 1.5 to 14 years. Six (37%) patients had chronic gouty arthritis, ten (63%) patients were in the attack-free period. All the patients had metabolic syndrome, 7 (43.7%) of them suffered from diabetes mellitus type 2. Arterial hypertension was diagnosed in 12 (75%) patients. Thickness of the intima-media complex (IMC) of the carotid arteries was measured in 12 patients with duplex ultrasonic scanning. Solid phase enzyme immunoassay studied serum concentrations of a soluble form VCAM-1 (sVCAM-1) and von Willebrand factor antigen (WF:Ag) as laboratory markers of endothelial activation. The above immunoassay was also used to study acute phase inflammatory changes by the levels of C-reactive protein (CRP). RESULTS: Concentration of sVCAM-1 in gout was 1385.2 +/- 341.0 ng/ml and was significantly higher than in the control group (p < 0.001). Mean values of WF:Ag and CRP in the serum were also significantly higher in the study group. The levels of both sVCAM-1 and WF:Ag were elevated in 25% patients. CRP was elevated (8 mg/l) in 6 (37.5%) patients. They had no infectious complications and age-, duration- and stage-related specific features of the disease. There was no significant differences between mean levels of sVCAM-1, WF:Ag, CRP in patients with diabetes mellitus and metabolic syndrome. There was no correlation between uric acid level and IMC thickness (r = 0.12; p > 0.05). A weak positive insignificant correlation was found between concentration of CRP, sVCAM-1 and IMC thickness of the carotid arteries (r = 0.28 and r = 0.36, respectively; p > 0.05). However, this index significantly correlated with WF:Ag(r = 0.62; p < 0.05). A moderate positive but insignificant correlation was detected between the levels of sVCAM-1 and WF:Ag (r = 0.47; p > 0.05). Concentration of sVCAM-1 weakly correlated with that of CRP (r = 0.35; p > 0.05). WF:Ag and CRP levels correlated significantly (r = 0.51; p < 0.05). CONCLUSION: Increased concentrations of sVCAM-1 and WF:Ag in gout reflect not only activation of vascular endothelium but also development of atherosclerotic process in these patients.

Adult↗

PubMed1992

[Recurrent thromboses of the Björk-Shiley valve in a patient with gout].

A 56-year-old male, who had mitral stenosis and gout, underwent mitral valve replacement with the Björk-Shiley valve prosthesis. Four years after the surgery, the patient suddenly became dyspneic on exercise due to malfunctioning valve. Thrombosis was found on the prosthesis, which was replaced again by Björk-Shiley valve. Thrombotest value had been satisfactorily controlled at 12.8 +/- 4.2% with warfarin since the first surgery. Dilazep chlorate also had been prescribed. Hyperuricemia had been controlled with allopurinol. In spite of these combined medical therapy, thrombosed valve recurred. Clotted prosthesis was superseded by Carpentier-Edwards Bioprosthesis. Enhancement of platelet function of the patients with gout and hyperuricemia has been reported. Gout in this case might have influence on the recurrent episodes of thrombosis. Monitoring of platelet function would be necessary in follow-up of a patients with gout and valve replacement.

Equipment Failure↗

PubMed1990

[The preservation of a DNA repair disorder in continuous-line fibroblasts obtained from gout patients].

DNA repair was explored in continuous cells withdrawn from gout patients. The data obtained were compared to those on primary cells (lymphocytes) from the same patients. Two continuous lines of fibroblasts obtained from the biopsy material of patients suffering from gout were examined for stability of reparation defects on long cell passage. The studies were made with 4 to 12 passages of patients' fibroblasts. The use of criteria reflecting certain stages of DNA repair (reparative synthesis of DNA, formation of induced DNA ruptures and their resynthesis during cell postincubation, reactivation and induced mutagenesis of measles vaccine virus in patients' cells) allowed confirmation of repair defect stability in gout patients' cells on their long passage. Based on the data on preservation of the repair defect on cell passage it is concluded that gout patients demonstrate the genetically determined impairment of the synthesis of DNA repair enzymes participating in the recovery of DNA impairments induced by UV radiation or UV mimetics.

4-Nitroquinoline-1-oxide↗

PubMed1990

Precocious familial gout with reduced fractional urate clearance and normal purine enzymes.

Gout is primarily a disease of middle-aged males and is unusual in females and adolescent males. We describe 21 young men and women (mean age 28 years) referred because of precocious onset of gout or hyperuricaemia. Fifteen patients had a family history, but known hereditary causes of primary or secondary hyperuricaemia were excluded. A high proportion (14/21) also had reduced renal function, but there was no clear relationship between this and the hyperuricaemia. Only two patients were hypertensive. A striking abnormality was that the uric acid clearance relative to creatinine [FEur] was subnormal (mean 4.4 +/- 1.4 per cent) in 15/21 patients, including all seven females. A dominantly inherited defect in renal tubular urate handling, leading to a reduced endogenous urate clearance, is the most likely explanation for the hyperuricaemia in this group. Only six patients, all male had a normal [FEur] (mean 8.6 +/- 1.0 per cent). The results confirm that young men and women with gout-or hyperuricaemia disproportionate to the renal dysfunction-should always be investigated, not only for purine defects, but also for abnormalities of renal urate handling. Since the abnormality described here was found also in symptomless subjects, the families of such patients must also be studied. Early identification is important since treatment may ameliorate the renal damage. Although rare, the number of such patients seen in a single referral unit suggests that this type of renal tubular defect in urate handling is more common than suspected and may only come to attention through an isolated episode of precocious gout, when renal function may already be impaired.

Adolescent↗

PubMed1987

Comparative trial of azapropazone and indomethacin plus allopurinol in acute gout and hyperuricaemia.

This study compared the effects of azapropazone and indomethacin plus allopurinol in the management of acute gout and hyperuricaemia. A group of 93 patients predominantly based in general practice were randomly allocated to the two treatment regimens (azapropazone (days 1-225) or indomethacin (1-28) followed by allopurinol (29-225)) on a double-blind double dummy basis. Azapropazone produced a substantial reduction in serum uric acid levels by day 4 compared with day 1 (P<0.002) and was superior to indomethacin with regard to recorded levels of serum uric acid at day 4 (P<0.01) and day 28 (P<0.05). From day 28 onwards allopurinol produced and azapropazone maintained similar reductions in serum uric acid. Both treatments rapidly controlled the initial acute attacks of gout and both produced side effects similar in frequency and nature. Fewer breakthrough attacks of gout occurred in the azapropazone group (12) than the indomethacin/allopurinol group (21).Although the results achieved in both treatment groups were similar it has been shown that azapropazone is effective monotherapy for controlling both acute attacks of gout and hyperuricaemia.

Adult↗