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PubMed1982

Purine synthesis de novo in lymphocytes from patients with gout.

1. Variables that affect the measurement of purine synthesis de novo in human lymphocytes were studied and a reliable method of measurement of purine synthetic activity in these cells was established. 2. Purine synthesis de novo was measured as the rate of incorporation of [14C] formate into alpha-N-formylglycinamide ribonucleotide when further steps in the biosynthetic pathway had been blocked by azaserine. Incubation was carried out in a synthetic medium with a high phosphate concentration (25 mmol/l). 3. Purine synthesis de novo was measured in lymphocytes obtained on several occasions both from control subjects and from patients with gout, particularly those who tended to overproduce urate as suggested by high values of urinary urate. 4. Lymphocytes obtained from each individual on different occasions showed considerable variations in purine biosynthetic activity. This variation was such that there was no difference between the mean values obtained for the gouty subjects and the control subjects. 5. No correlation was obtained between the mean purine synthetic activity de novo in lymphocytes and either the serum urate concentration or the 24 h urinary urate excretion on a purine-free diet. 6 Apart from those with recognized enzyme mutations, no subgroup of the gouty population has been demonstrated in whom isolated lymphocytes demonstrate an intrinsic abnormality of purine synthesis de novo.

Adult↗
PubMed2002

Flexor tendon rupture caused by gout: a case report.

We present a case of primary gouty infiltration of flexor tendons in the hand, causing rupture of both flexor digitorum superficialis and profundus tendons in a single digit. The patient was managed by a single-stage reconstruction of the less involved flexor digitorum superficialis tendon using a segment of the proximal stump of flexor digitorum profundus tendon as a bridge graft. This uncommon etiology of tendon rupture should be considered in all patients with a history of gout presenting with tendon insufficiency.

Gout↗
PubMed2001

Self-treatment for gout.

After describing some of the symptoms of gout and considering some causes, such as an excess of ethanol, the source of the pain in the infected joint is discussed. This is known to be from urate crystals formed in the synovial fluid inside the joint. It is suggested herein that the pain is due to grinding from the crystals through the surface film of the joint, and possibly into the bone itself, which is relatively soft. The pain then stems in part from the resulting inflammation. The key hypothesis is that these urate crystals dissolve on warming. Hence, by warming the joint concerned in hot water, and moving the joint around to encourage diffusion, the urate concentration is reduced and crystals no longer form, provided the treatment is continued.

Gout↗
PubMed1978

[Juvenile gout with decreased activity of hypoxanthine-guanine-phosphoribosyl transferase and pheochromocytoma: partial persistence of tophi despite uric-acid reducing treatment for 12 years (author's transl)].

A now 45-year-old man with marked chronic tophous gout and recurrent nephrolithiasis has been followed for 12 years. First gouty symptoms appeared at age 18. Uric-acid reducing treatment freed the patient of symptoms, and bony and soft-tissue tophi in part regressed. The early onset and high urinary uric-acid excretion indicated increased uric-acid production. Decreased activity of the enzyme hypo-xanthine-guanine-phosphoribosyl transferase was demonstrated to be the cause of the hyperuricaemia, which led to an excessive purine synthesis. An almost complete loss of activity of this enzyme is the basis of the Lesch-Nyhan syndrome. In the described patient all of the neurological and behavioural disorders of the Lesch-Nyhan syndrome were absent. A pheochromocytoma was found to be the cause of malignant hypertension, which had been present for many years.

Adrenal Gland Neoplasms↗
PubMed1989

[Infratemporal gout tophus--a rare differential diagnosis in primary parotid gland disease].

Soft-tissue tophi can be observed in up to 50% of patients with primary gout. They are firm deposits of monosodium urate in crystal form, which develop from pinhead-size to egg-size in the subcutaneous tissue. In the field of ear, nose, and throat diseases tophi have been described in such rare locations as the wing of the nose, the tongue, the epiglottis, and the arytenoid and thyroid cartilage. Tophus formation at the temporomandibular joint with extension into the fossa infratemporalis has been mentioned only three times in the world literature. -In the present paper, the authors report on the extraordinary location of an urate tophus in the fossa infratemporalis - in this case, there was even destruction of the middle base of the skull - which had been misinterpreted for years, having been diagnosed as a primary disease of the parotid gland.

Aged↗
PubMed1983

Human hypoxanthine (guanine) phosphoribosyltransferase: an amino acid substitution in a mutant form of the enzyme isolated from a patient with gout.

We have investigated the molecular basis for a deficiency of the enzyme hypoxanthine (guanine) phosphoribosyltransferase (HPRT; IMP:pyrophosphate phosphoribosyltransferase, EC 2.4.2.8) in a patient with a severe form of gout. We reported in previous studies the isolation of a unique structural variant of HPRT from this patient's erythrocytes and cultured lymphoblasts. This enzyme variant, which is called HPRTLondon, is characterized by a decreased concentration of HPRT protein in erythrocytes and lymphoblasts, a normal Vmax, a 5-fold increased Km for hypoxanthine, a normal isoelectric point, and an apparently smaller subunit molecular weight. Comparative peptide mapping experiments revealed a single abnormal tryptic peptide in HPRTLondon. Edman degradation of the aberrant peptide from HPRTLondon identified a serine-to-leucine amino acid substitution at position 109. This substitution can be explained by a single nucleotide change in the codon for serine-109 (UCA leads to UUA). Thus a mutation at the HPRT locus has now been defined at the molecular level.

Amino Acid Sequence↗
PubMed1978

Treating gout: successful methods of prevention and control.

For control of acute episodes of gout, administration of a full course of colchicine is the preferred method of therapy. This drug also is useful in prophylaxis of recurrent attacks, taken daily in combination with one or more drugs that influence uric acid metabolism. Weight reduction if the patient is obese, a balanced diet with restriction of foods high in purine content, and high fluid intake also are recommended.

Acute Disease↗
PubMed2003

Carpal tunnel syndrome secondary to intratendinous infiltration by tophaceous gout.

Carpal tunnel syndrome caused by gout is rare. We describe a case of entrapment of the median nerve secondary to intratendinous infiltration by gouty tophi in a 54-year-old man. The tophus was excised from the profundus tendon but the superficialis was too infiltrated and destroyed to be saved. The patient made an uneventful recovery with relief of his symptoms. This case illustrates the potential consequences this could have for hand function.

Carpal Tunnel Syndrome↗
PubMed1989

Development of the gout tophus. An hypothesis.

Sequential stages have been demonstrated in the development of individual focal deposits of crystalline urate and associated cell infiltrates within subcutaneous gout tophi. The findings suggest that acini of macrophages are formed and that active cellular transport of urate from the interstitial fluid into the central zones of these structures accounts for the focal nature of crystallization within the tophus. This process seems to account for the formation of focal urate deposits up to some 1.5-2 mm in diameter. The corona then commonly disappears and adjacent deposits may fuse. These events may lessen the consequences of hyperuricemia.

Aged↗
PubMed2000

Reduced secretion of proinflammatory cytokines of monosodium urate crystal-stimulated monocytes in chronic renal failure: an explanation for infrequent gout episodes in chronic renal failure patients?

BACKGROUND: In gouty arthritis, monosodium urate (MSU) crystals interact with monocytes and neutrophils to produce inflammatory reactions associated with acute synovitis. In patients with end-stage renal disease (ESRD), gouty arthritis is a rare condition despite often severe hyperuricaemia. We wondered whether differences in the secretion of proinflammatory cytokines by MSU crystal-stimulated monocytes might be one explanation for the low incidence of gouty arthritis in patients with ESRD compared with healthy controls. METHODS: Thirteen patients with ESRD on intermittent haemodialysis treatment, six patients with chronic renal failure not yet on dialysis, and 15 age- and sex-matched healthy controls were examined. Monocytes, purified from peripheral blood mononuclear cells (PBMC) by immunomagnetic bead separation, were incubated for 18 h in the presence of MSU crystals, Escherichia coli lipopolysaccharide (LPS) or medium alone. The supernatants were studied for the presence of interleukin (IL)-1beta, IL-6 and tumour necrosis factor-alpha (TNF-alpha) using cytokine-specific enzyme-linked immunosorbent assays. RESULTS: Monocytes from patients with ESRD produced significantly lower amounts of IL-1beta, IL-6 and TNF-alpha after stimulation with MSU crystals or LPS than did monocytes from healthy subjects. Cytokine production was not significantly different between ESRD patients on haemodialysis and chronic renal failure patients not yet on dialysis. Artificial MSU crystals were stronger stimuli than tophus-derived 'natural' MSU crystals. CONCLUSION: We demonstrate that monocyte-associated immunosuppression in ESRD leads to reduced secretion of proinflammatory cytokines in response to stimuli such as MSU crystals. This may be one of the factors preventing many ESRD patients from the manifestation of acute gout despite often severe hyperuricaemia.

Adult↗
PubMed1984

Azapropazone--a treatment for hyperuricaemia and gout?

In a metabolic ward study of five patients, azapropazone lowered plasma uric acid but exerted only a modest and variable uricosuric effect without altering urinary xanthine and hypoxanthine levels. An alternative mechanism other than uricosuria or xanthine oxidase inhibition must account for some of the hypouricaemic action of this drug. During the first day of treatment urine volume and pH declined sharply. In a separate investigation, 22 patients were given azapropazone and 18 were given allopurinol combined with colchicine for 3 months. Allopurinol reduced plasma uric acid more quickly but at the end of the study there was little difference in the hypouricaemic results achieved by both drugs. Recurrent gout occurred more frequently with allopurinol but side-effects were confined to those taking azapropazone. A slight rise in blood urea and creatinine and a fall in haemoglobin were also features of long-term azapropazone treatment.

Adult↗
PubMed1994

Polynesian women are also at risk for hyperuricaemia and gout because of a genetic defect in renal urate handling.

The prevalence of asymptomatic hyperuricaemia among Polynesian women (Maoris, Cook Islanders, Samoans, Tongans) was high--44%. This hyperuricaemia resulted from a reduced fractional uric acid clearance (FEur: uric acid clearance factored by creatinine clearance x 100--6.7 +/- 1.5%) compared with the FEur in healthy UK women (12.8 +/- 2.9%). This reduction in FEur was not as great as that in young UK women with familial juvenile hyperuricaemic nephropathy (FJHN: 5.1 +/- 1.5%) and was not associated with impaired renal function. The FEur in the normouricaemic Polynesians (9.7 +/- 1.9%) was also lower than that in healthy UK women (12.8 +/- 2.9%). The reduced FEur in these Polynesian women supports the hypothesis that indigenous Pacific races share a similar genetic defect in renal urate handling to that reported as the basis for the susceptibility to hyperuricaemia in Maori men. Neither alcohol nor hypertension contributed to this. This study also confirmed that, compared with their European counterparts, Polynesian women have a high purine intake and a strong tendency to obesity which increases with age. These factors, together with the reduced FEur, put them at added risk for gout. However, the reduction in FEur was not as great as that reported for the normouricaemic or asymptomatic hyperuricaemic Maori male (4.9 +/- 1.5% and 3.9 +/- 1.4%, respectively), confirming the same sex difference in renal urate handling in adult Polynesians as in caucasians.

Adult↗
PubMed1987

Gout presenting as lobular panniculitis.

A 37-year-old man presented with panniculitis of the legs that, on biopsy, showed aggregates of crystals whose appearance suggested sodium urate. Based on this finding, a uric acid level was obtained which proved to be markedly elevated. The patient subsequently developed gouty arthritis. Gout should be added to the differential diagnosis of causes of panniculitis, and biopsy specimens of panniculitis should be carefully examined for crystals.

Adult↗
PubMedDate not supplied

Dissected popliteal cyst: an unusual presentation of acute gout.

A 46-year-old man with acute gout and a dissected popliteal cyst presented with clinical features which mimicked rheumatoid arthritis and thrombophlebitis. The clinical and laboratory diagnosis of the case are presented and similar cases previously reported are briefly reviewed.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Dissected popliteal cyst: an unusual presentation of acute gout.

A forty-six year old man with acute gout and a dissected popliteal cyst presented with clinical features which mimicked rheumatoid arthritis and thrombophlebitis. The clinical and laboratory diagnosis of the case are presented and similar cases previously reported are briefly reviewed.

Arthritis, Rheumatoid↗
PubMed1988

A structural approach to pathological crystallizations. Gout: the possible role of albumin in sodium urate crystallization.

The interactions between sodium urate monohydrate (MSU) crystals and human serum albumin (HSA) were investigated in vitro in relation to the disease of gout. It was found that HSA accelerates (by up to ten times or even more) the nucleation of MSU crystals at a pH of more than 7.5, but only to a much lesser extent (1.2 times) at pH 7.0. Protein denaturation, as well as blocking exposed carboxylate groups on the protein, substantially reduced the nucleating effect. By use of immunofluorescence, immunogold labelling and crystal morphology studies, albumin was shown to interact preferentially with the (110) faces of MSU crystals. Taking these results into consideration, a mechanism is proposed whereby albumin stabilizes MSU crystal nuclei by interaction of structured carboxylate-containing protein domains with planes of the incipient crystal exposing sodium cation layers.

Crystallization↗
PubMed1980

Congenital dyserythropoietic anaemia (CDA) with severe gout, rare Kell phenotype and erythrocyte, granulocyte and platelet membrane reduplication: a new variant of CDA type II.

A 43-year-old man with lifelong anaemia showed features which indicate him to have a previously undescribed variant of congenital dyserythropoietic anaemia (CDA), type II. The main clinical features--of which the first two are unique or very unusual in CDA--have been severe tophaceous gout, massive splenomegaly, gall stones mecessitating cholecystectomy and haemosiderosis affecting the liver and probably the heart. At age 41 he sustained a spontaneous retinal detachment. In the peripheral blood there were large numbers of nucleated red blood cells and marked macrocytosis; otherwise the picture was typical of CDA type II. The bone marrow contained many bi- and multi-nucleated erythrocyte precursors. There were increased levels of a number of red cell enzymes and a slightly raised level of HbF. Uncharacteristically, the red cells failed to lyse with acidified normal serum. The cells were strongly agglutinated by anti-i and were of the rare Kpb-negative phenotype. Plasma lipid analysis showed very low levels of cholesterol and vitamin E. Lipid peroxidation was markedly increased. Ultrastructural studies showed reduplication of the erythrocyte, granulocyte, and platelet cell membranes.

Adult↗
PubMed1979

Partial deficiency of hypoxanthine-phosphoribosyltransferase:evidence for a structural mutation in a patient with gout.

A mutant hypoxanthine-phosphoribosyltransferase (EC 2.4.2.8.) from a patient with gout is examined. The activity of the erythrocyte enzyme is about 5% of normal in this case. Immunoprecipitation studies using antiserum against highly purified human hypoxanthine-phosphoribosyltransferase reveal that the patient's erythrocytes contain a normal amount of cross-reacting material. The mutant enzyme has an altered net charge as shown by preparative isoelectric focusing (pI values of 5.75 and 4.55). The influence of chemical modification on enzymic activity was studied using a number of different reagents directed against sulfhydryl-, amino-, and guanidino-groups. Compared with normal hypoxanthine-phosphoribosyltransferase the mutant enzyme shows a generally lowered susceptibility to active site-directed inhibition. It is concluded that the patient's enzyme is the product of a structural mutation.

Erythrocytes↗