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PubMed1958

Atypical manifestations of gout.

Atypical occurrence of gout (in a 37-year-old Negro woman and in an 11-year-old girl) and atypical manifestations (involvement of both hands and both feet, and of shoulders, elbows, wrists or ankles) are reported in a study of five cases. Because specific and effective therapy for gout is available, and because the diagnosis, once suspected, is readily confirmed by estimation of plasma uric acid content and by therapeutic trial, it becomes more urgent to recognize that gout is a fequently overlooked diagnosis.

Female↗
PubMed2003

[Case report: MRI findings in gout].

MR imaging is not routinely used for the evaluation of tophaceous gout. However, gout may have atypical clinical and radiologic findings. It should be considered in the differential diagnosis when a mass reveals heterogeneous and low signal intensity on T2 weighted images. We present MR imaging characteristics of gout tophi and arthritis in two patients.

Aged↗
PubMedDate not supplied

[Diagnosis and treatment of gout in Mexico City. Results from a physicians survey].

UNLABELLED: The diagnosis and proper treatment for gout were described decades ago but these guides are not always realized in all the patients. OBJECTIVES: To evaluate by a mail survey sent to general physicians (GP), internal medicine physicians (IM), orthopedists (OP) and rheumatologists (RP) from Mexico city, the way they diagnose and treat gouty patients. SUBJECTS AND METHODS: The survey was anonymous and included 20 questions, it was sent by mail to 1,836 physicians (640 GP, 640 OP, 423 IM and 133 RP) living in Mexico city. RESULTS: The response was 6.8% OP, 10.4% IM, 10.8% GP and 41.4% RP. Eighty two to 95% of them attend gouty patients. Diclofenac was the drug most frequently used as the treatment for acute attacks, although a high frequency of glucocorticoids and allopurinol prescription for acute gout attacks was detected (28% OP and 49% GP respectively). Allopurinol is the drug more frequently used for the chronic treatment, it is also used for asymptomatic hyperuricemia by 43-84% of the physicians. Twenty five percent do not adjust initial allopurinol doses to glomerular filtration rate. The prophylactic treatment is used in only some cases and the dietetic restrictions were variable. Some points regarding the treatment of these patients are not according those recommended in the literature. CONCLUSIONS: We need to increase the knowledge between physicians about gout diagnosis and proper treatment. The adequate treatment is in most of the cases safe, cheap and effective.

Acute Disease↗
PubMed1992

Recurrent hemarthrosis associated with gout.

Gout commonly occurs as an acute arthritis. In a 64-year-old man, gout was associated with a proliferative hemosiderin-laden synovitis. The association of recurrent atraumatic hemarthrosis seems not to have been reported in the literature on gout.

Gout↗
PubMed1992

Acute gout involving the acromioclavicular joint following treatment with gemfibrozil.

Gout affecting the acromioclavicular joint is extremely rare. We describe a case of acute gout involving the acromioclavicular joint in a patient with seronegative spondyloarthropathy, following use of the fibric acid derivative, gemfibrozil. This case broadens the differential diagnosis of acute acromioclavicular joint arthritis; further studies are needed to determine if there is a causal relationship between use of gemfibrozil and an acute attack of gout.

Acromioclavicular Joint↗
PubMedDate not supplied

Spinal cord compression by tophaceous gout with fluorodeoxyglucose-positron-emission tomographic/MR fusion imaging.

A 36-year-old woman presented with lower extremity paralysis. Her past medical history included gout. Conventional radiography and MR imaging revealed bone erosion and soft tissue lesions of the thoracic spine. Fluorodeoxyglucose-positron-emission tomographic (FDG-PET) images revealed hypermetabolic lesions of the thoracic spine. A CT-guided biopsy was diagnostic for inflammatory tophaceous gout. This case describes the CT, MR, and FDG-PET imaging characteristics of acute inflammatory gout. FDG-PET imaging characteristics of this disorder have not been previously described.

Adult↗
PubMed2006

A survey of current evaluation and treatment of gout.

OBJECTIVE: To record diagnostic and treatment approaches to gouty arthritis among US rheumatologists. METHODS: Questionnaires were faxed to 2500 US rheumatologists. RESULTS: Responses were received from 518 rheumatologists. Respondents reported performing crystal analysis 80% of the time for new suspected gout; 64% use combination therapy for acute gout; nonsteroidal antiinflammatory drugs alone are used in only 27%. Urate-lowering drugs (ULD) are given to most patients. ULD treatment is given occasionally to patients with asymptomatic hyperuricemia (4%) but most frequently to patients after 2 (59%) or 3 (34%) attacks. ULD are given with the aim of achieving a serum urate (SU) level of 6 mg/dl. CONCLUSION: Combination antiinflammatory agents are used frequently for acute gout despite absence of evidence in the literature to support this practice. There seems to be consensus regarding the necessity of lowering SU to < 6 mg/dl. Approaches vary widely, supporting the need for longterm prospective, placebo controlled studies to provide more evidence-based guidance.

Adrenal Cortex Hormones↗
PubMed2006

[Research on relationship of syndrome type and parameters of hemorheology and platelet activation in patients with acute gout arthritis of dampness-heat blockage type and stasis-heat accumulate type].

OBJECTIVE: To study the relationship between syndrome type and the parameters of hemorrheology and platelet activation in patients with acute gout arthritis of dampness-heat blockage (DHB) type and stasis-heat accumulation (SHA) type. METHODS: Forty patients with acute gouty arthritis were divided into 2 groups according to TCM syndrome differentiation, the DHB group (n=24) and the SHA group (n=16), and 20 healthy people were taken as the control group. Hemorrheological parameters, platelet activating factor (PAC-1) and P-selection (CD62p) in them were detected. RESULTS: Plasma viscosity, outcome of erythrocyte sedimentation and K value of its equation, levels of PAC-1 and CD62p were higher, erythrocyte electrophoresis index was significantly lower in gout patients of both types than those in the control group (all P < 0.01), and the levels of PAC-1 and CD62p in the SHA group were higher than those in the DHB group (P < 0.05). CONCLUSION: DHB type and SHA syndrome type of acute gout arthritis are correlated with parameters of hemorrheology and platelet activation, and the different levels of these pameters showed in the two types, may be the internal factors for their genesis.

Acute Disease↗
PubMed1991

Gout and hyperuricemia.

Accurate diagnosis is essential since gout is overdiagnosed by a factor of three. Asymptomatic hyperuricemia is not associated with adverse consequences and should not ordinarily be treated. The acute attack of gout responds to any nonsteroidal anti-inflammatory drug, and antihyperuricemic therapy with allopurinol, probenecid or sulfinpyrazone is effective in lowering uric acid and preventing further attacks. Except for prophylaxis, colchicine is not recommended for the treatment of gout because of unacceptable levels of toxicity. Diet therapy, once a mainstay of treatment, is usually not indicated since drug therapy alone is far more efficacious.

Chronic Disease↗
PubMed1990

[Clinical studies on hyperuricemia and gout after transplantation].

We performed renal transplantation on 67 patients (living 37, cadaver 30) between November 1975 and December 1987. Twenty-seven of the 67 patients had hyperuricemia (serum uric acid: male greater than or equal to 8.0 mg/dl, female greater than or equal to 7.0 mg/dl) and 2 of them had episodes of gout. However, there was no correlation between serum creatinine and uric acid in 27 hyperuricemic patients. Twelve of 27 hyperuricemic patients were treated with either allopurinol or benzbromarone. These therapies were effective for 9 of them and serum uric acid level controlled well. One of 2 gouty patients developed gout 4 years after cadaveric renal transplantation. She was treated with anodyne and benzbromarone for gout. These treatments were effective and she has been in good condition. We consider it necessary to treat hyperuricemia after renal transplantation and to control serum uric acid well.

Adult↗
PubMed1990

Is asteroid hyalosis ocular gout?

In 76 cases of asteroid hyalosis, seven (9.2%) had gout, eight (10.5%) had close relatives with gout, and two (2.6%) were in both categories. Three of the gouty seven were receiving gout medications. Serum uric acid measurements were elevated in 28.3% of the 46 cases (60.5%) measured. In the 68 monocular cases (89.5%), whites (57 cases) showed no right/left predilection, but blacks (11 cases) had 100% left eye involvement (P less than .001). From a review of 49,000 records, prevalence rates were calculated for discrete age and sex groups. Females under age 60 had no asteroid hyalosis. After age 60 they had a constant prevalence rate of one case per 600 (0.15%). Males of all ages had a higher prevalence rate than females, increasing with age to one per 126 (0.79%) in the 80-or-older group. In all 76 patients, the male-to-female ratio was 1.45:1. Among whites it was, 1.74:1, and among blacks, 0.63:1.

Age Factors↗
PubMed1989

Tuberculous arthritis presenting as tophaceous gout.

A 73-year-old black man with chronic gout presented with a 1 1/2 year history of a swollen painful left wrist. Two draining ulcers over the ventral aspect of his wrist and radiographic changes of the affected area suggested chronic gouty arthritis, but culture of the fluid from the wrist grew Mycobacterium tuberculosis. This case extends the list of infectious agents producing septic arthritis in patients with gout to include Mycobacterium tuberculosis. The need for culture evaluation of joint fluid in patients with chronic as well as acute gout is emphasized.

Aged↗
PubMed1979

Secondary hypertriglyceridemia and hyperlipoproteinemia in patients with primary asymptomatic gout.

We carefully selected 30 men with primary gout, rendered asymptomatic by therapy, to examine the frequency and type of hyperlipidemia and hyperlipoproteinemia, with the objective of determining whether serum uric acid, alcohol intake, liver function, kidney function, and (or) drugs were participating in the secondary lipid disorder. Sixty-one age- and sex-matched men were used as controls. About 73% of the gout patients had hypertriglyceridemia, 1.6-fold the frequency found in the control group. Types IV and IIb lipoprotein electrophoretic patterns were most prevalent in the gout group. Neither alcohol intake nor hyperuricemia, per se, seems to be the cause of the lipid and lipoprotein disorder and cannot be related to liver or kidney dysfunctions. Obesity was the major underlying factor associated with the lipidemia. The study suggests that diet and, possibly, defective clearance of triglycerides may be etiologic factors associated with the abnormal serum triacylglycerol (triglyceride) and lipoprotein concentrations in these individuals.

Blood Chemical Analysis↗
PubMed1989

[Clinical importance of changes in antibody immunity in gout].

In 77 patients with gout (16 with acute attacks and 61 during an attack-free period), in 30 healthy subjects, 30 patients with IgM RF serum positive rheumatoid arthritis (RA) and 20 cases of IgM RF serum negative RA the authors examined serum values of 10 parameters of antibody immunity: IgA, IgG, IgM, IgD, IgE, beta-2 microglobulin (beta-2 MG), immunocomplexes (IK), IgM RF/LFT, IgM/RF/HAT and ANA/IF. Data obtained by quantitative analyses were processed by stepwise discrimination with the consecutive selection of characteristics significant for the differentiation of the investigated groups and by assessment of classification functions which make it possible to classify individuals selected at random. The authors consider the following particularly important from the clinical aspect: acute gouty attack--IgM RF serum positive RA (IK and beta-2 MG), attack-free stage of gout--healthy subjects (IgA, IgG, IgM, IgD, IK, IgE). IgM RF were detected in 5/77 patients with gout, ANA/IF not in a single patient.

Acute Disease↗
PubMed1989

Intermittent control of hyperuricemia in the treatment of gout.

Fifty patients with gout were randomly allocated to one of 2 groups receiving allopurinol, either continuously or for 2 months every year. Patients with renal functional impairment or tophacous gout were excluded. Duration of treatment ranged from 2-4 years. Acute gouty arthritis occurred to a similar degree in the 2 groups during the first year, but thereafter attacks occurred with diminishing frequency in the continuous group compared with the intermittent group. We concluded that the intermittent administration of allopurinol as given here is less effective in controlling symptoms of gout than continuous therapy.

Allopurinol↗
PubMed1989

Lipid studies in primary gout.

Serum total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride were measured in three groups of male patients with primary gout. The groups were defined by the presence of 0, 1, or more than 1 coexisting medical conditions or cardiac risk factors (coronary heart disease, hypertension, diabetes, proteinuria, overweight). Mean values of total, LDL, and HDL cholesterol were lower in patients with one or more associated conditions than in those with none. By contrast, triglyceride levels were significantly higher and exceeded the desirable range. Distributions of individual values of all lipid parameters except triglycerides were similar along the three groups. Triglyceride values, however, were significantly higher in patients with multiple complications. Observed differences in lipid values could not be correlated with patient age or type of nature of medication received. High triglycerides and LDL cholesterol are not a feature of uncomplicated gout in men. HDL cholesterol tends to be normal and triglyceride mildly elevated. Only in patients with two or three associated medical conditions are high triglycerides or low HDL cholesterol common. Our results suggest that these findings are independently related to concurrent disease and that gout is not necessarily in itself a risk factor for cardiovascular or diabetic disease.

Adult↗
PubMed1987

[Incidence and various risk factors for gout in the Georgian SSR].

The results of simultaneous epidemiological surveys of the adult population (7000 persons) in the city of Tbilisi and workers at 7 enterprises of the machine-building and mining industries (9189) have shown that 0.29% of the population, mainly men aged over 40 with hereditary predisposition, obesity, carbohydrate metabolic derangement, consuming food rich in purine bases, national flavorings and spices, suffer from gout. A high prevalence of gout among workers of the mining industry and early age at the onset of disease suggest probable association of gout with some industrial factors (manganese, tungsten, molybdenum, bismuth).

Adolescent↗
PubMed1978

[Physiopathological bases for a rational therapy of gout].

Rational therapy of gout must be correlated with the two basic aetiopathogenetic factors, i.e. metabolic error and the inflammatory dysreactive moment. Due to its different action mechanism, the former is responsible for the typing of adult primary hyperuricaemia: a) hyperincorporating and hyperescretory forms; b) normo-incorporating and relatively or absolutely hypoexcretory forms; c) hyperincorporating and hyposcretory forms. It would be a mistake to treat the condition chemically without knowing the physiopathology of the metabolic error. On the basis of a preliminary typing assessment, rational chemical correction of the metabolic error in gout cases can be achieved with drugs that block the enhanced endogenous synthesis of uric acid (allopurinol, etc.) or correct the metabolite renal excretion defect. Therapy of the dysreactive-inflammatory component should involve non-steroid anti-inflammatory drugs. The disadvantages of using cortisones in gout treatment are stressed.

Allopurinol↗