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PubMed1987

[Current clinical course of gout].

A many-year investigation of 254 primary gout patients aged 21 to 78 was carried out to reveal characteristic features of a course of gout under present-day conditions. It has been established that gout is characterized by the onset at an earlier age, frequent involvement of the cardiovascular system and kidneys in the process. Coronary heart disease was detected in 43.3% of the patients, renal lesions in 44.7%. Multiple articular lesions, frequent and prolonged exacerbations and noticeable hyperuricemia were typical of the male patients under 40. Gout in the female patients was characterized by the atypical onset and a milder course.

Adult↗

PubMed1986

A comparison of gout in men and women. A 10-year experience.

The clinical features of gout in men and women are compared in a retrospective study of hospital patients and outpatients attending an arthritis clinic. Men had a readily recognized pattern of disease in terms of age of onset, duration of disease, and tophaceous gout. Recurrent mono-arthritis of the big toe metatarsophalangeal joint culminating in tophaceous polyarticular gout after many years was a stereotyped pattern. In women, polyarticular/tophaceous disease was often the first manifestation of gout, and a preceding recurrent mono-arthritis was found in joints other than the big toe. The duration of disease before tophi appeared was shorter. The use of diuretics was commonplace, and associated disease such as hypertension or chronic renal failure is frequent in women.

Adult↗

PubMed1985

Ocular abnormalities in patients with gout.

We examined 69 patients with severe gout in a search for associated ocular diseases-particularly evidence of uveitis. None of the 69 patients had evidence of uveitis, past or present. Three patients had asteroid hyalopathy. The most common abnormality was bilateral ocular redness caused by hyperemia of the conjunctival and episcleral vessels. This was present in at least 43 of the 69 patients. Our findings support the evolving belief that in the past gout was assigned far too important a role as a causative factor in uveitis, and they confirm the well-described (but not generally recognized) clinical picture of red eyes in patients with gout. When evaluating a patient who is troubled by bilateral chronic conjunctival redness, the clinician should consider gout in the differential diagnosis.

Adult↗

PubMed1985

[Attacks of gout and thromboembolic disease: role of heparin therapy].

The authors report 4 cases of acute gout in the lower limb occurring soon after starting heparin therapy for venous thromboembolic disease. As none of the usual factors which induce gout were present, the possible roles of the venous thrombosis and the heparin therapy were examined. Intra-articular thermic and acid-base changes secondary to the thrombosis could have explained the site of the attacks of gout in 3 of our 4 patients; the fourth patient had normal phlebography; the relationship between the attack and the start of heparin therapy suggested that the heparin may have induced the gout, possibly by an interaction with the synovial proteoglycans leading to the precipitation of urate crystals in the joint. In the absence of references in the literature, these hypotheses need further confirmation.

Acute Disease↗

PubMed1969

Current concepts of hyperuricemia and gout.

Recent studies have confirmed that gout is an inborn error of metabolism. It has now become evident that the hyperuricemia associated with gout might occur either due to overproduction of uric acid, underexcretion of uric acid or a combination of these processes. Furthermore, patients with excessive purine synthesis may have a specific enzyme defect resulting in altered feedback inhibition of purine synthesis. A neurological disease manifest by mental retardation, choreo-athetosis, aggressive behavior, lip-biting and self-mutilation and associated with decidedly increased purine biosynthesis serves as a prototype of this kind of disorder. Other defects in regulation of purine biosynthesis have been postulated but their existence not yet confirmed. It has been demonstrated that urate crystals which are deposited from hyperuricemic body fluids set up an acute inflammatory reaction by means of a variety of chemical mediators. Thus, acute gouty arthritis is now recognized as an example of "crystal induced" synovitis. The treatment of gout consists of (1) the control of acute gouty attacks, and (2) the maintenance of normal serum uric acid concentrations. This latter may be achieved either with uricosuric drugs or with xanthine oxidase inhibition. With these principles in mind, it is now possible to avoid many of the severe crippling effects of gout and to restore the vast majority of gouty patients to useful and productive lives.

Chemical Phenomena↗

PubMed1978

[Uptake of 2-C14 urate by erythrocytes in hyperuricemia and in gout (author's transl)].

The uptake of 2-C14 urate by erythrocytes was measured in 19 patients with primary hyperuricemia, 6 patients with secondary hyperuricemia, 17 patients with primary gout and 30 controls. The uptake of urate in patients with primary gout was significantly lower than in the controls. In contrast no such difference could be observed in patients with primary and secondary hyperuricemia. The uptake of labeled urate by erythrocytes from gouty patients is especially diminished in the early phase of the uptake kinetics. The possible relevance of this finding for the pathogenesis of urate precipitation in gout is discussed. Further, we consider the application of the tracer urate uptake by erythrocytes as an aid in the early diagnosis of gout.

Erythrocytes↗

PubMed1982

[Hallux rigidus arthrosis and gout].

In general, 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. But as a reevaluation of this problem shows, no criteria can be stated as to causal relationship between hyperuricemia (or gout) and hallux rigidus arthrosis. Obesity has to be considered a connecting link between both of them, and it is accelerating their genesis. Hallux rigidus arthrosis represents, like the arthrosis of Heberden the most frequent possibility for confusing it with gout.

Calcium↗

PubMedDate not supplied

Ulnar deviation of the fingers in gout simulating rheumatoid arthritis.

Two cases of gout with marked ulnar deviation (UD) are reported. Both cases were previously diagnosed rheumatoid arthritis (RA) at referral, but gout was clinically suspected because of atypical features of RA, and subsequently confirmed by demonstration of monosodium urate crystals under the polarized microscope. No definitive evidence of associated RA was present in either case. Although UD in gout is distinctly rare, it is important to recognize this deformity in gout in order to avoid inappropriate therapy. Mechanical factors might have contributed to the hand deformities in both cases.

Aged↗

PubMedDate not supplied

[Various epidemiological aspects of hyperuricemia and gout in Mexico: incidence and the cardiovascular risk factor].

We studied the prevalence and the risk factor among the patients of gout in Mexico. Research was conducted in the National Institute of Cardiology and in our private practice. Prevalence of hiperuricemia and gout in the Institute of Cardiology was of 1% (970 out of nearly 100,000 patients). We divided those cases of two subgroups: Reumatology patients (333) and Cardiovascular patients (529). In the first group primary gout was (96.3), and (50.32% in the second. Risk factor was quite different too: nephropathy 9.9%, lithiasis 9.3%, pyelonephritis 2.7%, cardioangiosclerosis 12.9%, aortosclerosis 6.6%, coronary insufficiency 6.3%, myocardial infarction 0.9%, arterial hypertension 24.6% obesity 56.1% and diabetes 9.9% in the Reumatology group; in the Cardiovascular one, nephropathy 14.3%, lithiasis 12.2%, pyelonephritis 7.1%, cardioangiosclerosis 62.7%, aortosclerosis 31.7%, coronary insufficiency 24.9%, myocardial infarction 29%, arterial hypertension 51%, obesity 54.8% and diabetes 20.4%. Among the private practice patients prevalence was of 10.1% (961). In an early age (39 years) in men and a later one for women (53 years). Other characteristics of epidemiology and risk factor are: primary gout 89%, atherosclerosis 5%, coronary disease 4.6%, lithiasis 4.7%, nephropathy 2%, pyelonephritis 1%, obesity 43%, and diabetes 4.6%. In an small group of patients of our private practice we made an exhaustive study of risk factor and the metabolic disorder of lipids. We found the following frequency: 9.3 of nephropathy, 31.2% of lithiasis, 18.7% of pyelonephritis, 68.9% of cardioangiosclerosis, 46.8% de coronary insufficiency, 9.3% of myocardial infarction, 68.7% of arterial hypertension, 68.7% of obesity and 18.7% of diabetes. In the lipid profile we found an increase in triglicerids and prebeta lipoprotein. We have amply discussed the relation between hiperuricemia and pathology considered as a risk factor from the genetic point of view as well as the metabolic and circumstancial aspect. From all that we concluded that risk is multifactorial.

Adult↗

PubMedDate not supplied

Coexistence of chronic tophaceous gout and rheumatoid arthritis.

The coexistence of chronic tophaceous gout and rheumatoid arthritis (RA) in the same patient is extremely rare. Only 6 cases, considered genuine, including ours, have been reported. With 1 exception, all the reported cases, including our own, were males and gout was the initial disease followed years later by the development of RA. We are proposing modified criteria for the definite diagnosis of RA and gout in the same patient to avoid the inclusion of many patients with chronic topaceous gout, who would otherwise fulfill the American Rheumatism Association criteria for RA. We stress the importance of fixation of biopsy material in formalin and alcohol to avoid diagnostic errors, since granuloma with histologic features resembling a rheumatoid nodule or rheumatoid synovitis may show the presence of crystals of monosodium urate when examined with compensated polarized light microscopy.

Arthritis, Rheumatoid↗

PubMed1980

Simultaneous gout and pyarthrosis.

Although infrequently reported, the simultaneous occurrence of gout and infection in the same joint has been noted recently in three patients at the University of Virginia Hospital. Our report suggests that gout and pyarthrosis may coexist more often than is generally recognized and emphasizes the necessity of carefully searching for both conditions in an inflamed joint. The importance of adequately treating gout occurring with infection is also illustrated. Although speculative, factors such as synovial fluid pH, endotoxin, and enzymatic digestion of articular cartilage may predispose an infected joint to acute gout.

Aged↗

PubMed1995

Urate-oxidase for the treatment of tophaceous gout in heart transplant recipients. A report of three cases.

Gout in heart transplant recipients is common and poses a significant therapeutic challenge. Concomitant administration of azathioprine and allopurinol therapy carries a high risk of leukopenia. Uricosuric agents can cause renal lithiasis and/or acute renal failure in patients with renal failure and/or high urinary levels of uric acid. We report our experience with urate-oxidase in three heart transplant recipients with severe polyarticular and tophaceous gout, a history of leukopenia under allopurinol and unresponsiveness or contraindications to uricosuric agents. Urate-oxidase was given parenterally in a dosage of 1000 units per day, seven days a month. The injections were done intramuscularly in one patient and intravenously in the other two, who were under anticoagulant therapy. Patients 1 and 2 received 12 and 6 courses, respectively. The third patient had had four courses and was still under treatment at the time of this writing. Shrinking of the tophi and improved mobility of the fingers were seen in all three patients after the second course. No adverse effects were recorded. Our experience suggests that urate-oxidase therapy may decrease the urate burden in patients with severe tophaceous gout. Urate-oxidase therapy should be viewed as a phase in the treatment of gout, which must be followed by administration of another agent.

Adult↗

PubMedDate not supplied

Serum uric acid levels and gout: what does this herald for the population?

OBJECTIVE: To compare the Rome and New York criteria for gout. METHODS: The Rome and New York criteria were compared in 59 patients with gout and in 761 with non-gout by calculating statistical indices such as sensitivity, specificity, relative value (sensitivity + specificity) and the log-likelihood ratio. RESULTS: The best individual criterion was one or more attacks of podagra (New York version) which had a relative value of 194. In contrast, the presence of a tophus was the least valuable criterion with a discriminatory value which was less than three times the most valuable (podagra). The rarity with which either response to Colchicine therapy or measurement for urate crystals were sought makes them poor criteria. Serum uric acid (SUA) followed an approximate Normal Distribution in both sexes, although there were some interesting differences across age strata. In males, SUA showed a progressive rise with age interrupted by a hiccup in the mid-40s. In females, SUA fell slowly as menstruation started, followed by a gradual postmenopausal rise. The mean SUA in males was 294 mumol/l (95% CI = 278-330 mumol/l) and in females 230 mumol/l (95% CI = 224-236 mumol/l). CONCLUSION: Despite higher levels of SUA in gouty patients, there was no lower level of SUA from which gout was not diagnosed, which vindicates its removal from the New York criteria set.

Adolescent↗

PubMed1993

Gout and pseudogout.

This article describes the clinical spectrum of gout and pseudogout and discusses the role of colchicine, NSAIDs, and uric acid--lowering agents in the management of different stages of gout. A great majority of patients with gout are now seen and treated by primary care physicians. Strategy for successful management of gout and prevention of its disabling complications are discussed also.

Arthritis, Gouty↗

PubMed1996

[The trend of proportion among inpatients with gout in 21 hospitals during the past 15 years].

We analyzed data gathered from 21 hospitals in our country from 1979 to 1993 on the total number of hospitalized patients with the number of gout patients. Results showed that the proportion of hospitalized gout patients in 21 hospitals has increased sharply during the past 15 years (Chi2 = 823.4, P < 0.001). The constituent ratio of hospitalized gout patients in 13 hospitals in southern China increased abruptly (Chi2 = 650.9, P < 0.001); while the constituent ratio in 8 hospitals in northern China increased to a lesser extent (Chi2 = 188.1, P < 0.001). A significant difference was noticed between southern and northern China (Chi2 = 45.8, P < 0.001). During the past 15 years, the proportion of hospitalized gout patients has been increasing rapidly, with greater extent in the south. This is probably related to the economic development which improves the standard of living and to the changes of food structure.

China↗

PubMed1996

[Epidemiological, clinical and evolutive aspects of gout in the internal medicine department at Ouagadougou (Burkina Faso)].

The study reports the epidemiology and signs of gout at Ouagadougou from a group of 35 patients observed in a department of internal medicine. The diagnosis of gout was based on Rome criteria. The most important epidemiological factors associated with gout were: obesity, hypertension, alcohol and diabetes. 75% of the patients were male. Gout was chronic polyarticular form and tophis were observed in 5 cases.

Adult↗

PubMed1999

Intradermal tophi in gout: a case-control study.

OBJECTIVE: To describe the characteristics of intradermal tophi in patients with gout and search for factors associated with their development. METHODS: This is a case-control study of patients with gout: cases (Group A, n = 21) had intradermal (not subcutaneous) plaques of monosodium urate (MSU) crystals located in sites distant to articular or paraarticular structures, and controls (Group B, n = 42) had gout but no intradermal tophi. Both Group A and Group B were paired by sex, age (+/-5 years), and duration of the disease (+/-3 years). Analysis included serum and urinary uric acid levels at first visit, radiographic stage of gout, the presence of associated diseases, and previous therapy, specifically, chronic glucocorticoid and diuretic usage. RESULTS: Intradermal tophi were located in the legs, forearms, buttocks, thighs, arms, and abdominal wall. Patients in Group A had a greater number of nonintradermal tophi in common sites (11.9+/-12.5 vs. 4.2+/-7.9, mean +/- SD; p = 0.018), decreased glomerular filtration rate (46.74+/-25.11 vs. 70.87+/-30.18 ml/min; p = 0.042), advanced radiographic changes (57.2 vs. 7.1%; p = 0.0001), and longterm glucocorticoid self-medication (76 vs. 36%; p = 0.006). We found no differences in other associated diseases between groups. CONCLUSION: Intradermal tophi were commonly found in the legs and forearms, and less frequently in the buttocks, thighs, and abdominal wall of gouty patients, and were associated with longterm self-prescribed glucocorticoids and chronic renal failure. The occurrence of intradermal tophi in these patients appeared to correlate with advanced disease.

Adult↗

PubMed2026

Efficacy and Safety of Ultra-Low Starting Dose Febuxostat Titration in Male Patients With Primary Gout.

BACKGROUND: Since gout is a common metabolic arthritis caused by urate crystal deposition, urate-lowering therapy (ULT) is clearly indicated, but the initiation of ULT frequently causes paradoxical acute flares that in turn impair patient adherence. OBJECTIVE: This study sought to assess the effectiveness and safety of an ultra-low-dose initiation strategy for febuxostat (10 mg/day) compared to the standard starting dose (20 mg/day) in reducing initiation-related flares while maintaining long-term urate control. METHODS: 120 male patients with primary gout presenting with acute arthritis were randomly assigned to initiate febuxostat at 10 mg/day (Group A) or 20 mg/day (Group B), with protocol-mandated biweekly titration. The primary outcomes were gout flare frequency over 24 weeks (assessed using Poisson regression), serum uric acid (SUA) target attainment, and the incidence of adverse events. RESULTS: Although both groups achieved comparable target SUA levels by week 24, Group A demonstrated a significantly lower overall flare incidence (36.7% vs. 70.0%; p < 0.001), along with a greater percentage of flare-free patients (70.0% vs. 46.7%; p = 0.016). Multivariable Poisson regression revealed that Group B had an approximately twofold higher risk of flares compared to Group A (Incidence Rate Ratio = 1.95; p = 0.012), with obese patients deriving the most pronounced benefit from the ultra-low-dose approach. To avert one additional flare, the calculated number needed to treat was 4.3. Additionally, the occurrence of clinically significant liver injury (ALT/AST > 3× ULN) was low in both groups, with 3.3% in Group A and 1.7% in Group B. Multivariable regression analysis confirmed that LDL-C is an independent predictor of ALT (β = 12.90, p = 0.009), while febuxostat dosage was not linked to hepatotoxicity. CONCLUSION: Initiating febuxostat at a dose of 10 mg/day with gradual titration demonstrates a superior safety profile by effectively reducing early acute flares without compromising long-term urate control, which is particularly advantageous for high-risk cohorts, including obese patients.

Humans↗