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PubMed1994

[Double tunnel syndrome of the upper limb in tophaceous gout. Apropos of a case].

Association of two tunnel syndromes secondary to tophaceous gout is uncommon. This article presents a case of ulnar and carpal tunnel compression. It concerns a 71 year old man with gout and treated for that condition. He presented with paraesthesiae in the fingers and loss of muscular strength in right hand. Physical examination discovered two masses, one in the epitrochlear groove, the other in the olecranon bursa; a severe ulnar palsy and a carpal tunnel syndrome. Neurolysis of both ulnar and median nerves was performed. After 2 years follow-up, paraesthesiae disappeared but atrophy of ulnar intrinsic muscles remained unchanged. The literature is reviewed. Carpal tunnel syndrome is well known in gout (28 reported cases), and is secondary to gouty tenosynovitis. Ulnar tunnel syndrome has been described once by Akizuki in 1984. The combination of the two conditions has not been previously been reported. In our case, median nerve compression was secondary to gouty synovitis but also to a bulky tophus from the floor of the carpal tunnel.

Aged↗
PubMed1995

Gout and hyperuricaemia.

We have recounted the remarkable story of gout and hyperuricaemia in the indigenous populations of the Pacific and noted the recent identification of the same problem in communities in rural Indonesia. Gout is increasingly recognized in African populations, especially in urban centres. There is no doubt that gout is 'alive and well' and presents a continuing challenge to future generations in developing countries.

Acute Disease↗
PubMed2004

[Gout nephropathy--ghost or reality?].

Until the past decades, end stage renal disease was considered a major cause of death among patients with gout. Modern long-term follow up studies of renal function however have indicated that hyperuricemia and gout rarely result in kidney damage unless other renal diseases supervene. Subsequently, the use of the EDTA lead mobilization test confirmed that gout in the presence of chronic renal failure is a useful marker of chronic lead intoxication. Chelation treatment with EDTA can slow the progression of renal insufficiency, without apparent damage associated with the use of the chelating agent. Since chronic lead intoxication may remain clinically concealed for years, a high index of suspicion is warranted. Occult lead intoxication should be sought actively in gouty patients with chronic renal insufficiency of unknown etiology.

Diagnosis, Differential↗
PubMed2006

Gout-associated uric acid crystals activate the NALP3 inflammasome.

Development of the acute and chronic inflammatory responses known as gout and pseudogout are associated with the deposition of monosodium urate (MSU) or calcium pyrophosphate dihydrate (CPPD) crystals, respectively, in joints and periarticular tissues. Although MSU crystals were first identified as the aetiological agent of gout in the eighteenth century and more recently as a 'danger signal' released from dying cells, little is known about the molecular mechanisms underlying MSU- or CPPD-induced inflammation. Here we show that MSU and CPPD engage the caspase-1-activating NALP3 (also called cryopyrin) inflammasome, resulting in the production of active interleukin (IL)-1beta and IL-18. Macrophages from mice deficient in various components of the inflammasome such as caspase-1, ASC and NALP3 are defective in crystal-induced IL-1beta activation. Moreover, an impaired neutrophil influx is found in an in vivo model of crystal-induced peritonitis in inflammasome-deficient mice or mice deficient in the IL-1beta receptor (IL-1R). These findings provide insight into the molecular processes underlying the inflammatory conditions of gout and pseudogout, and further support a pivotal role of the inflammasome in several autoinflammatory diseases.

Animals↗
PubMed2002

Tophaceous gout of the spine: MR imaging features.

AIM: To define the magnetic resonance (MR) imaging features of tophaceous gout of the spine. MATERIALS AND METHODS: We present the MR imaging examinations of 4 patients with spinal tophaceous gout. Spin-echo T1-weighted and fast spin-echo T2-weighted images were obtained for all patients, and 2 patients had gadolinium-enhanced MR imaging studies. Corresponding computed tomography (CT) was performed in one patient. All images were evaluated for the characteristics of the gouty tophi. RESULTS: The gouty tophi were located at the lower thoracic (n=1) and lumbar (n=3) levels. All tophi yielded homogeneous intermediate to low signal on T1-weighted images and variable signal intensity on T2-weighted images, comprising small foci of very low signal intensity on all sequences. Gadolinium-enhanced MR imaging studies revealed homogeneous enhancement or heterogeneous peripheral enhancement. Diffuse stippled calcifications were found in the tophi on CT images. Periarticular tophi with juxtaarticular bony erosions around facet joints occurred in 3 patients. CONCLUSION: Spinal tophaceous gout should be considered in the differential diagnosis when periarticular deposits contain very low signal foci on all MR imaging sequences.

Adult↗
PubMed1982

[Carpal tunnel syndrome and gout (author's transl)].

Bilateral carpal tunnel syndrome was observed in a 39-year-old female with gout. Until now carpal tunnel syndrome caused by gout has not been observed in females. Due to marked clinical symptoms neurolysis on the right side had to be performed. The course of the left hand affection was observed while on conservative treatment with a xanthine oxidase inhibitor. As such therapy is possible and successful, it is mandatory to diagnose carpal tunnel syndrome early in gout. Histology showed the cause of carpal tunnel syndrome to be uric acid tendovaginitis.

Adult↗
PubMed2004

Community-based study in Taiwan aborigines concerning renal dysfunction in gout patients.

OBJECTIVE: To reveal the factors associated with renal dysfunction among gout patients in Taiwan aborigines. METHODS: Social demographic data, alcohol consumption data, anthropometric measurements, blood samples, and 24-h urine samples were collected from 128 aboriginals (101 men, 27 women) suffering from gout. RESULTS: The men displayed higher mean creatinine clearance (Ccr) values than women. Twenty-two post-menopausal women had significantly lower Ccr values compared to the five pre-menopausal women [probability (p)<0.001]. The males displayed higher 24-h urinary creatinine value than females (8.60+/-5.39 versus 5.58+/-2.14 mmol/L; p<0.05), and showed a significantly higher positive relationship between 24-h urinary creatinine and uric acid excretion [correlation coefficient (r)=0.7304; p<0.001], whereas the females did not (r=0.1144; p=0.5691). Overall, those who were older members of the Tsou tribe, or had excreted less uric acid from urine in 24 h tended to suffer renal dysfunction. CONCLUSIONS: Gout patients displayed diversity in renal function. An exogenous source of creatinine in men was more likely than in women.

Adult↗
PubMed1982

The prevalence of gout in three English towns.

The prevalence of gout has been measured in three English towns by means of a postal questionnaire. The three towns were selected to give a range of socio-economic conditions. In each town questionnaires were sent to a sample of approximately 5000 men aged 45 to 74 years. The questionnaire elicited a history of gout and a history of an attack of severe pain in the great toe. There was a progressive increase in prevalence of gout from Ipswich, the town with the most favourable socio-economic status, through Wakefield to Preston, the town with the least favourable socio-economic status. Within each town there was no difference between the social class distribution of cases and age-matched controls

Aged↗
PubMed1978

The gout patient in general practice.

A study of the clinical profile of gout-diagnosed patients was undertaken within general practice in Great Britain. At the time of the first attack of acute gouty arthritis, the mean age was 52.3 years and 15.6% of the total 1077 patients were female. Males had an earlier clinical onset than females and the average frequency of attacks of acute gouty arthritis was 0.91 per patient year. Ten per cent of the cases were believed to be secondary gout, with diuretic therapy the most frequent cause. The sample showed a highly significant association between gout and the higher social classes, a family history among blood relatives in 23% of cases, tophi were noted in 4.6% of cases where sought and 38.2% of cases were 10% or more overweight and significantly heavier than a non-gouty population. The great toe joint was most frequently involved, both in the first episode and in all acute episodes combined. The most frequently occurring associated chronic condition was hypertension which was present in 27.8% of cases. Renal stones occurred in 6.1% and renal impairment in 2.2%. Only 20.4% of the patients were referred to hospital, with the younger being referred more frequently than the older. Those with joint involvement other than the great toe had a greater chance of being referred, as did those who also had angina pectoris, myocardial infarction and hypertension. Allopurinol appeared to be the drug of choice for long-term control therapy and phenylbutazone for the acute attack.

Adolescent↗
PubMed1992

Gout due to renal disease.

From 120 patients attending a referral gout clinic, 12 patients were found to have primary renal disease at the time of, or prior to, their first attack of acute gouty arthritis. This number excluded those with chronic lead nephropathy, polycystic kidneys or who were receiving diuretics. The nature of the renal disease was usually of the tubulointerstitial variety rather than of glomerular origin. The renal clearance of urate per unit of glomerular filtration rate, which usually increases with renal disease, was generally reduced, suggesting impairment of renal excretion of urate. Nine of the patients were female (four premenopausal) and only three were males. The degree of renal impairment was only mild to moderate. Other common associations with gout, such as obesity, hypertension and regular alcohol consumption, were not prominent. The intrinsic renal disease in these patients was considered to be the major contributor to their development of hyperuricaemia and gout.

Adult↗
PubMed2004

Gout complicated with necrotizing fasciitis--report of 15 cases.

OBJECTIVE: To analyse the clinical features and outcomes of gout complicated with necrotizing fasciitis. METHODS: From the database of our hospital, we identified 15 hospitalized cases of gout complicated with necrotizing fasciitis from 1987 to 2001. The medical records of the patients were analysed in detail. RESULTS: Mean patient age was 54.7 +/- 12.8 yr. Fever was found in only 10 (66.7%) patients, while the remaining five patients were afebrile on presentation. The peripheral blood white count was raised in only nine (60%) patients. The median time from the onset of symptoms to hospital visit was 4 days (range 2 to 25). Formation of bullae occurred in 60% of patients. Six patients had previous wound infection, two patients had concomitant septic arthritis and the remaining seven patients had no obvious source of infection. Diabetes mellitus and iatrogenic Cushing syndrome were each found in three patients. The identified causative microorganisms were Gram-positive cocci (eight cases) and Gram-negative bacilli (four cases); but in three patients the causative organisms were unknown. Thirteen patients received surgery, including amputation in four cases. Finally, six patients suffered septic shock, three of whom died as a result. CONCLUSIONS: Necrotizing fasciitis in gout patients represents a surgical and medical emergency, and is associated with a high mortality rate. Prompt diagnosis and treatment is imperative and may be lifesaving. Early diagnosis requires a high level of suspicion, even in patients without fever or leucocytosis.

Adult↗
PubMed1995

Gout, uric acid metabolism, and crystal-induced inflammation.

Serum triglyceride levels are significantly higher and serum high-density lipoprotein cholesterol levels are lower in patients with gout compared with healthy individuals. Whereas increased serum triglyceride levels exist intrinsically in gout, serum uric acid concentration correlates inversely with insulin sensitivity and positively with serum triglycerides. Interaction of monosodium urate crystals with granulocyte-macrophage colony-stimulating factor and with tumor necrosis factor-activated neutrophils favored the production of interleukin-1 over that of interleukin-1-Ra, resulting in a proinflammatory imbalance. Interaction of the crystals with iron or tyrosine kinase may modify their inflammatory response and can be an important modulating mechanism in gouty arthritis. E-selectin is a specific marker for synovial fluid soluble endothelial activity and is increased in the synovial fluid of patients with gouty arthritis, as well as in that of patients with other inflammatory arthritides. Similarly, E-selectin was found to be high in joints with monosodium urate crystal-induced synovitis. In addition, synovial fluid levels of interleukin-8 were found to be high in gout, rheumatoid arthritis, and osteoarthritis.

Aged↗
PubMed1997

Gout and hyperuricemia.

Although there continue to be relatively few basic studies of the metabolism and transport of urate, clinical interest in gout and hyperuricemia remains high. A number of interesting new observations are described here from the published literature of the past year. Various aspects of the diagnosis, management, and pathophysiology of gout and gouty arthritis have been recently reviewed. The therapy of gout and hyperuricemia continue to lead to significant complications.

Crystallization↗
PubMed2001

Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaemia and gout.

OBJECTIVE: Losartan has been shown to increase urinary uric acid excretion and hence to lower serum uric acid levels. The purposes of the present study were: (1) to evaluate the effects of losartan on serum uric acid in hypertensive patients with hyperuricemia and gout, (2) to compare the effects of losartan with those of irbesartan, another angiotensin II receptor antagonist and (3) to evaluate whether losartan 50 mg b.i.d. has a greater impact on serum uric acid levels than losartan 50 mg once a day. METHODS: Thirteen hypertensive patients with hyperuricaemia and gout completed this prospective, randomized, double-blind, cross-over study. Uric acid-lowering drugs were stopped 3 weeks before the beginning of the study. Patients were randomized to receive either losartan 50 mg or irbesartan 150 mg once a day, for 4 weeks. During this phase, a placebo was given in the evening. After 4 weeks, the dose was increased to losartan 50 mg b.i.d., or irbesartan 150 mg b.i.d. for another 4 week period. Subsequently, the patients were switched to the alternative treatment modality. Enalapril (20 mg o.d.) was given during the run-in period and between the two treatment phases. Serum and urinary uric acid were measured at the beginning and at the end of each treatment phase. RESULTS: Our results show that losartan 50 mg once daily decreased serum uric acid levels from 538 +/- 26 to 491 +/- 20 micromol/l (P < 0.01). Irbesartan had no effect on serum uric acid. Increasing the dose of losartan from 50 mg o.d. to 50 mg twice a day, did not further decrease serum uric acid. This may in part be due to a low compliance to the evening dose as measured with an electronic device. Indeed, whatever the prescribed drug, the mean compliance of the evening dose was always significantly lower than that of the morning dose. The uricosuric effect of losartan appears to decrease with time when a new steady state of lower serum uric acid is reached. CONCLUSIONS: In contrast to irbesartan, losartan was uricosuric and decreased serum uric acid levels. Losartan 50 mg b.i.d. did not produce a greater fall in serum uric acid than losartan once a day. Losartan might be a useful therapeutic tool to control blood pressure and reduce serum uric acid levels in hypertensive patients with hyperuricaemia and gout.

Aged↗
PubMed2000

Lumbar radiculopathy secondary to gouty tophi in the filum terminale in a patient without systemic gout: case report.

OBJECTIVE AND IMPORTANCE: Gouty arthritis and gouty tophi of the spine are very rare. We present a patient with the clinical manifestations of an intradural tumor and histologically proven gouty deposits in the filum terminale. CLINICAL PRESENTATION: The patient presented with typical symptoms of lumbar radiculopathy and neurogenic claudication. There was no evidence of peripheral gout. INTERVENTION: Imaging studies, including computed tomography and magnetic resonance imaging, demonstrated a 1-cm, round, intradural, calcified lesion at the L3 vertebral level, causing moderate spinal stenosis. The patient underwent a two-level laminectomy and removal of the mass. A pathological examination of the specimen revealed gouty deposits in the region of the filum terminale. CONCLUSION: Spinal involvement in gout is very rare, and intradural gouty deposits have not been previously described. Intradural gout should be considered in the differential diagnosis of intradural masses.

Diagnosis, Differential↗
PubMed2003

The soft-tissue shaving procedure for deformity management of chronic tophaceous gout.

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. A gouty tophus occasionally mimics an infectious or neoplastic process. However, the conventional enucleating procedure might cause complications. In severe cases, skin necrosis and tendon or joint exposure can occur after debridements. In this series, the soft-tissue shaver is used for deformity management of the chronic tophaceous patients and the results are encouraging. From November 2000 to August 2002, 17 patients with chronic tophaceous gout were treated by the shaver technique. Suction and irrigation were performed simultaneously while the shaver was operating, and chalky deposits of sodium urate could be removed efficiently. Skin necrosis was minimized by means of proper incision planning. Also, bedside debridements and wound wet dressing were helpful for improving the outcomes. The families and patients were satisfied with the results. In conclusion, severe chronic tophaceous gout can be a surgical challenge. The soft-tissue shaving technique can be useful for cosmetic debulking of large tophi in patients with advanced chronic tophaceous gouty arthritis.

Adult↗
PubMed1997

Acute gout of the right sacroiliac joint.

An eighty-year-old woman suffered from acute idiopathic gout of the right sacroiliac joint and tophaceous deposits in two fingers of her right hand. Hyperuricemia and findings consistent with gout detected by histological examination of a biopsy specimen taken from the digital nodules supported the diagnosis. The radiological workup revealed osteolytic changes at the bases of the phalanges in Roentgenograms of the feet. Various aspects of the very rare incidence of sacroiliac gout are discussed.

Acute Disease↗
PubMed1977

The cartoon in doctor-patient communication. Further study of the Arthritis and Rheumatism Council handbook on gout.

A sample of 50 consecutive patients with gout was tested by means of a multiple-choice knowledge-testing questionnaire based on the Arthritis and Rheumatism Council's Gout: A Handbook for Patients. Patients were divided into two groups: (a) those tested with an illustrated booklet containing 89 cartoons, and (b) those tested with an unillustrated booklet with text exactly the same as in the illustrated booklet. No significant difference was observed in either the overall test scores between the two groups or between individual question scores. It was concluded that increasing the number of illustrations in the Arthritis and Rheumatism Council's handbook on gout had not significantly increased the value of this material as a communication aid. Certain sources of error have been discussed including the possibility of an 'interest factor' due to the inevitable interest patients have in reading about their own disease, and also the possibility that technical factors to do with page layout and picture/text imbalance might be responsible for failing to show differences between the two groups.

Cartoons as Topic↗