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PubMed1977

[Therapy of gout].

The therapy of gout is discussed taking into consideration the concomitant diseases occurring significantly frequently in patients with gout: Hypertension, uric acid-nephrolithiasis, hyperlipoproteinaemia, obesity, premature arteriosclerosis as well as diabetes mellitus. In contrast to other opinions the authors are of the opinion that the dietetic treatment is furthermore of essential importance. It is referred to the still allowed sufficiently great number in the supply of nourishment, in which cases, however, the limitations in the supply of calories, protein or purin bodies, respectively, lipid and carbohydrate do not remain unmentioned. The propositions for the medicamentous treatment essentially correspond to the central therapeutic recommendations. For the acute attack of gout, however, following to the international experiences, the colchicine therapy is more emphasized again. The medicamentous therapy of the asymptomatic hyperuricaemia is to be included into the considerations after full exhaustion of all dietetic and other possibilities in constant increase of the serum-uric acid-level more than 8 mg/dl.

Arteriosclerosis↗
PubMedDate not supplied

The medical/surgical management of gout.

Hyperuricemia and gout are common clinical entities. The pathogenesis, clinical presentation, and medical/surgical management of gout are reviewed. A case of chronic tophaceous gout exemplifying the multifaceted nature of the disease is presented.

Aged↗
PubMed1986

[Echodiagnosis of the kidney lesion in gout].

An echographic study of the kidneys was performed in 24 men with proved gout aged 40 to 50 and a disease duration of 10-20 yrs. On the basis of case history data urolithiasis was noted in 4 patients, whereas by echodiagnosis it was found in 12. Cysts were detected in 6 patients with gout complicated by urolithiasis and in 1 patient without it. Echoroentgenography was shown to be a highly informative method in the diagnosis of urolithiasis and cystic regeneration of the kidneys opening up prospects for earlier treatment of complications in gout.

Adult↗
PubMed1987

[Gout in women].

An analysis of clinical symptoms and characteristic features of a course of gout in 10 women (3.4% of 290 gout patients) has shown that gout patients can represent a heterogeneous group in terms of age, predisposing causes (hereditary predisposition, change in a hormonal pattern, obesity and iatrogenic effects like the use of diuretics), concomitant pathology and variants of a disease course. Two clinical variants have been defined: classical in which disease develops during or after occurrence of menopause along a favorable course, without tophi and signs of chronic arthritis, and atypical which develops at a younger age, has a grave course and can rapidly progress (chronic polyarthritis with frequent recurrences can sometimes develop in the course of 2-3 yrs). No significant variations in the clinical picture were noted in comparison with those in men.

Acute Disease↗
PubMed1986

[Arthropathies and nutrition: gout].

Gout is a disease linked to altered uric acid metabolism with increased uric acid concentration in the blood, the deposition of sodium urate crystals in certain tissues and abscesses. Uric acid derives from ex novo purinogenesis and the catabolism of cellular and alimentary nucleic acids. It is eliminated by uricolysis mainly in the intestines and renal excretion. The restriction of dietary protein purines, fats and calories reduces uricemia and explains the relationship between gout and diet. In Europe 5-18% of adult males suffer from uricemia with gout occurring in 0.5-1%. The incidence among females is much lower. The clinical picture presents an acute phase with a gouty abscess linked to the swollen joints caused by sodium urate crystals and a chronic phase characterised by gouty tophi and chronic gouty arthropathy. Treatment of the acute phase in which ample use is made of colchicine must be followed by medical and dietary treatment of the chronic condition.

Adolescent↗
PubMedDate not supplied

Gout in females: an analysis of 92 patients.

Ninety-two females with gout are reported. The preliminary ARA criteria for acute gout classified 60% of the patients. Forty patients were diagnosed by finding tophi or urate crystals in the synovial fluid, 16 patients had the ARA clinical criteria for gout, and a further 36 patients were considered to have good clinical grounds for gouty arthritis. Classification of the patients was difficult. A subacute pauci-/polyarthritis was the presenting feature in 64 (70%) patients and in 49 (77%) there was no history of a preceding recurrent monoarthritis. Seventy-two patients (78%) were on diuretics. Tophi were usually indolent and showed little surrounding inflammation. 87% of the patients had an associated disease.

Adult↗
PubMed1979

[Therapy of gout].

Increasing incidence of gout and its importance as a risk factor for arteriosclerosis stimulate the practitioner to improve his knowledge about therapeutic possibilities. Therapy of gout includes (1) treatment of acute attack with colchicine and indometacin, (2) decrease of uric acid blood concentration in tophaceous gout using uricosurica, alkalinization of urin, increased diuresis, and blockade of de-novo synthesis of uric acid, and (3) maintenance therapy with allopurinol or uricosurica to avoid recurrent arthritis as well as tophi. In addition, surgical removal of larger tophi may be of benefit.

Allopurinol↗
PubMed1983

Preliminary studies with azapropazone in gout and hyperuricaemia.

Eight patients with acute gouty arthritis were treated with high dose oral azapropazone 600 mg qds in an open study in order to evaluate its therapeutic potential in acute gout. The drug appeared to be as effective as previous agents used in the management of individual patient's acute gout with resolution of pain in 2-21 days, and it had a potent hypouricaemic and uricosuric effect. The uricosuric effect of azapropazone 300 mg qds and phenylbutazone 100 mg tds was compared in a seven day cross-over study in seven asymptomatic patients with gout and hyperuricaemia. Azapropazone had a more rapid uricosuric effect than phenylbutazone. There was a statistically significant fall in serum uric acid and rise in uric acid clearance 24 hours after starting azapropazone and 72 hours following phenylbutazone.

Adult↗
PubMed1984

Factor XII deficiency in a man with gout and angioimmunoblastic lymphadenopathy.

A patient with factor XII deficiency, gout, and angioimmunoblastic lymphadenopathy (AIL) was seen initially for an acute myocardial infarction, gout, and unexplained urticaria. The patient eventually was found to have AIL and a prolonged partial thromboplastin time. There was no evidence of a circulating anticoagulant. A factor XII deficiency (Hageman factor) was discovered. The coexistence of a factor XII deficiency, AIL, and gout in the same person raises some interesting questions regarding the basic mechanisms of the inflammatory process.

Factor XII Deficiency↗
PubMedDate not supplied

[Clinical and socio-medical aspects of long term uricostatic treatment of primary gout (a 5-10 year study)].

In 60 patients (48 cases were evaluated) with primary gout a longterm therapy (5--10 years) with Allopurinol was performed. Without treatment 4.4 sudden onsets of gout per patient and year were registrated; under Allopurinol only 0.062 (p less than 0.001) onsets were observed. This resulted in a large decrease in hospitalisation time from 44 days to 0.62 days per patient and year. In the majority of cases involution or diminuation of the tophi was found. In 7 cases of nephrolithiasis no further renal colic took place. In 8.3% a skin rasch and in 12.5% a slight gastrointestinal side effect was observed. Together with the clinical results the socio-medical aspects are discussed and the importance of gout in respect to the socioeconomic point of view is pointed out.

Acute Disease↗
PubMed1980

[Therapy of acute attacks of gout using acemetacin (author's transl)].

In an open clinical study the efficacy and tolerability of [1-(p-chlorobenzoyl)-5-methoxy-2-methylindole-3-acetoxy] acetic acid (acemetacin, TV 1322, Rantudil) were studied in 15 patients (2 female and 13 male) suffering from acute arthritis urica. Basing on the heterogeneity of the patients it was possible to estimate the minimal dose of acemetacin necessary to treat slight, moderately severe and extremely severe forms of the complaint. With the exception of one patient who suffered from an extremely severe attack of gout, all patients were completely free from pain within 7 days of therapy. The same results were also valid for the parameters reddening, swelling and functional and impairment. In 12 of 15 cases the assessment of therapy was given as "good" by the patients as well as the physicians. In only one instance was it necessary to give colchizin concomitantly to ensure that the patient was free from pain. In this case, the gout, had over many years, assumed a chronic character and during acute attacks manifested to an almost generalised arthritis. Despite the relatively high daily doses--in some cases up to 600 mg/day--only one case of slight gastric disorder was recorded as an undesired side effect. This, however, did not necessitate withdrawing the drug. It can thus be concluded that acemetacin in the doses used in this study is effective in the therapy of acute gout and is well tolerated at relatively high daily doses.

Acute Disease↗
PubMedDate not supplied

Recurrent painful calf swelling associated with gout.

A 30-year-old man had a recurrent painful calf swelling associated with gout that mimicked thrombophlebitis and possibly muscle tear. This painful calf swelling occurred in the absence of a subjective history of arthritis of the knee. A constellation of clinical signs was highly suggestive that gout was the cause of the painful calf swellings. Patients with similar conditions, after careful exclusion of thrombophlebitis, might be spared unnecessary and potentially dangerous anticoagulation or surgical intervention by early diagnosis of gout.

Adult↗
PubMedDate not supplied

[Personality picture of gout patients].

41 male patients (from the Medical Polyclinic of the University of Munich) suffering from gout have been studied with the semi-standardized psychoanalytic interview and psychological test methods. The result was that all of the patients had a pathologic narcissistic personality. They could be divided up into two groups: two thirds of the patients corresponded with the "philobats" and one third with the "oknophiles" of Balint's concept. Some aspects of the interview data could be verified by the standardized psychological tests. Beyond the metaphoric classification with Balint's concept it was interesting to find parallels to M. Mahler's observations on the mother-child-relation. Corresponding interpretations were possible. Questions concerning the illness behavior, the first attack of the gout together with the psychological conflict were discussed. Further research programs are considered necessary. Nevertheless there are reasons to presume that gout is a multifactorial disease with alimentary, genetic and psychological aetiopathogenetic conditions.

Drinking↗
PubMed1995

Gout or 'pseudogout': how to differentiate crystal-induced arthropathies.

Gout is an inflammatory joint disease that primarily affects middle-aged men and postmenopausal women. It is characterized by severe pain and erythema in the big toe and other affected joints. Acute gout may be triggered by diuretics, aspirin, minor trauma, or acute illness. The presence of monosodium urate crystals within phagocytes from synovial fluid aspirates is almost always diagnostic. Calcium pyrophosphate deposition disease ("pseudogout") usually affects larger joints and often follows trauma, surgery, or ischemic heart disease. Microscopic examination of crystals under compensated polarized light is used to differentiate gout and pseudogout. Disorders involving basic calcium phosphate are often more difficult to diagnose and treat but are also less likely to be disabling.

Adult↗
PubMed1994

Gout during pregnancy.

A 34-year-old woman, 12 weeks pregnant, presented with an acute monoarthritis. Gout was proven by joint aspiration. The gout was multifactorial in origin. Only 2 cases of gout during pregnancy have been described previously.

Abortion, Spontaneous↗
PubMed1975

[Chronic lead poisoning: Lead gout with giant tophi on the skin, nephrophathy and porphyrinopathy].

Chronic lead nephtropathy, secondary gout (lead-gout) and porphyrinuria may develop after long lasting professional exposure to lead. A printer with giant tophi on his hands and feet excreted a significantly higher amount of lead after infusion of calcium EDTA in comparison with a normal control person. This result indicates an increased mobilization of lead from skeletal deposits. Furthermore, the laboratory findings showed renal insufficency and porphyrinuria up to 1316 mug/l (elevation of total porphyrins with slight or no elevation of delta-amino-levulic acid and porphobilinogene). The clinical triad nephropathy, secondary gout and porphyrinuria seems to be a variant of chronic lead poisoning.

Aged↗
PubMed1993

[The clinico-pathogenetic aspects of sex dimorphism in gout].

The examination of 241 gout patients (207 males and 34 females) revealed a marked sexual dimorphism of the disease related to the articular and renal syndromes. Male gout is characterized by higher blood levels of uric acid and oxypurinole in reduced clearance of the latter, while in female gout there were hyperxanthinoxidasemia and hypo-cAMPemia. Unbalance of sex and gonadotropic hormones, which appeared multidirectional and dependent on the sex, was observed in males in the form of lower concentrations of blood testosterone and estradiol against elevated levels of progesterone and lutropin, in females manifested with hypoprogesteronemia and reduced gonadotropin.

Arthritis, Gouty↗