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An assessment of quality of drug control of hyperuricaemia in gouty subjects is reported. Twenty seven of 40 patients were found to be hyperuricaemic. Factors influencing compliance with drug therapy included awareness of the nature of gout and excessive alcohol consumption.
The results of an open exploratory trial with different regimens of indoprofen in patients with acute gouty arthritis are described. Two main daily regimens were assessed: (a) indoprofen 200 mg as an intravenous bolus, followed by slow infusion of 100 mg/hour for about 4 hours (24 attacks treated in twenty-three patients); and (b) indoprofen 400 mg as an intravenous bolus (13 attacks treated in twelve patients). In both regimens intravenous indoprofen was supplemented with 400-600 mg daily of indoprofen by mouth. The patient's response, as judged by pain, tenderness, local heat, redness, range of motion and joint circumference, was dramatic in both series, with no significant difference between them at any time of observation. Substantial improvement was apparent for subjective variables already within 2 hours after the beginning of treatment, and a complete resolution was obtained in 35 of 37 attacks within 48 hours. A mild adverse reaction was recorded in one patient for each group (dizziness and gastric pain, respectively). Intravenous indoprofen appears to afford an extremely rapid relief of acute gout; of the two regimens assessed, the second should be preferred in that it seems to be at least equally effective but less troublesome for the patients.
Two gopher snakes (Pitophis melanoleucus catenifer) each were given 5 mg/kg body weight gentamicin every 72 hours (group 1); two snakes each were given 5 mg/kg/day (group 2). Doses for both groups were given over a 2-week period. After the second week, the dose for one snake in each group was increased to 50 mg/kg/day for 2 more weeks and then discontinued. Weekly renal biopsies taken from snakes in group 1 showed no abnormalities by light microscopy during and at the completion of the experiment. Snakes in group 2 had cloudy swelling of the proximal tubules at 2 and 4 weeks after the gentamicin was administered. Snakes given the high dose of gentamicin had hydropic degeneration of the proximal tubules 2 weeks after the dose was raised to 50 mg/kg/day. This progressed to tubular necrosis 1 week after the gentamicin was discontinued. These snakes (high dose) also developed visceral gout, apparently as the result of the extensive tubular necrosis. Tophi were in the pericardium, serosal membranes and parenchyma of the kidneys, liver, spleen and lungs.
In a general practice survey of gout, an analysis was made of the criteria relating to the diagnosis in 604 patients. Approximately 60% of diagnoses were made within 1 month of the patient presenting with symptoms; in the remainder, there was often a considerable time lag before diagnosis and half of these patients had been wrongly diagnosed initially. Of the total cases, approximately 8% were diagnosed in hospital and only about 20% of cases were referred for diagnosis or subsequent management advice. Most diagnoses were based on the presentation by the patient of a typical acute arthritis, and a raised serum urate level was used as a confirmatory factor. Few patients presented with tophi and response to colchicine was infrequently used in diagnosis, as were diagnostic X-rays or synovial fluid examination for crystals.
We report a patient who suffered an acute attack of gout in the wrist after surgical release for carpal tunnel syndrome. The postoperative management of this patient and a brief review of this complication of carpal tunnel release are discussed.
A case of a 23 year-old-man with a history of polyarthritis and chronic tophaceous gout is reported. He developed a crural paraparesis caused by sodium urate deposits in the spinal canal. Decompressive laminectomy and removal of urate-laden ligamentum flavum was performed without improvement. According to the literature there are nine cases previously reported.
Radiographs were available for study for 466 of 2,000 patients with primary gout who were followed clinically for as long as 30 years. The radiographic manifestations at various stages of the disease and the effect of therapy were studied in 80 patients. New radiographic signs, such as lace pattern, intracortical lesions, and subchondral compressions, are emphasized as well as the frequency of tophaceous lesions affecting the dorsum of the feet.
Intraosseous calcification in association with gouty arthritis was observed in six patients and a single cadaver. This finding, which is usually associated with chronic tophaceous gout, extensive articular destruction, and severe renal disease, is usually seen in the hands, wrists, and feet. It may be associated with additional calcific deposits in the adjacent soft tissues. Although the radiographic appearance of the calcification simulates that of an enchondroma or bone infarct, the abnormality seems related to intraosseous penetration of calcified urate deposits.
Immunoelectron microscopic (IEM) analysis of the surface coats of intracellular and extracellular monosodium urate (MSU) crystals in synovial fluid (SF) in gouty arthritis was performed using the ferritin-bridge method. Cells from patients with acute gout were fixed in 1% glutaraldehyde containing 0.05% saponin to permeabilize membranes for access of immunochemicals to intracellular antigens. Intracellular MSU crystals were observed in phagosomes of greater than 75% of both polymorphonuclear (PMNs) and mononuclear cells. Coating of crystals with IgG was more prominent than with IgM or IgA. Other proteins such as C3, and fibrinogen were also found to a lesser extent. Albumin was not detected in appreciable amounts on MSU crystals. Extracellular crystals also showed IgG to be bound more prominently than other proteins. The various proteins, shown here for the first time to be clearly associated with intracellular crystals by EM, and other materials associated with MSU crystals may influence the phlogistic properties of these crystals.
Tophaceous gout of the spine rarely causes spinal cord compression. Only eight cases have been reported previously. We report a further case presenting with progressive quadriparesis caused by gouty tophi at C1, treated successfully by decompressive laminectomy and internal fixation. This case and the previously reported cases are reviewed.
In a series of four experiments, diets containing oosporein at graded concentrations from 0 to 600 microgram/g were fed to male broiler chicks from hatching to 3 weeks of age. At dietary toxin levels of 100 microgram/g and below, no detrimental effects were observed. Dietary oosporein concentrations of 200 microgram/g and above elicited dose-related mortality resulting from severe visceral and articular gout. Three-week cumulative mortality percentages were 0, 13, 30, 57, and 95% for the 0, 200, 300, 400, and 600 microgram/g levels, respectively. Upon necropsy, the prominent lesions observed were massive urate deposits in various tissues, swollen and pale kidneys, dehydration, proventricular enlargement with mucosal necrosis, and a green discoloration of the gizzard lining. The effects on the proventriculus and gizzard occurred at doses as low as 200 microgram/g and were the most sensitive indicators of oosporein-toxicosis. In addition to the proventriculus, the relative weights of the kidney and liver were significantly increased in a dose-related fashion. A significant reduction in 3-week body weight at 400 microgram/g apparently resulted from the lower feed consumption concomitantly observed at this level of dietary toxin. Oosporein also caused an increase in water consumption at 400 and 600 microgram/g. Blood analyses indicated no toxin-related effect on plasma glucose, plasma protein, packed red blood cell volume, hemoglobin, and prothrombin times. The plasma concentration of uric acid was significantly elevated at 400 microgram/g. These data and mechanistic considerations suggest that oosporein should be classified as a nephrotoxin in the broiler chicken.
Multicentric reticulohistiocytosis is a rare cutaneous-articular disease that may mimic more common disorders such as rheumatoid arthritis or tophaceous gout. In one fourth of patients, it is a paraneoplastic process. This brief overview is aimed at physicians who care for patients with polyarthritis, to alert them to distinctive features that differentiate multicentric reticulohistiocytosis from the common arthritides.
By starting from the critical analysis of the fable "Gout and the spider"(Fables Choisies mises en vers, III,8) by Jean de La Fontaine, the author inquires into the historical and literary sources of such a tale. They lie in a short story by Francesco Petrarca ("Aranea et Podagra"), that can be found in a letter from the "Epistolae de Rebus Familiaribus" (III,13). Antecedent sources can be recognized in the Exempla by Jacques de Vitry and Jean Gobi, as well as in a brief poem by Paulus Diaconus.
OBJECTIVE: To assess the role of grayscale and power Doppler sonography in short-term monitoring of acute gouty synovitis. METHODS: Clinical and sonographic assessments were performed in a patient with gout. Clinical and sonographic evaluations were performed within the first day of the acute onset of synovitis of the first metatarsophalangeal joint of the left foot and 7 and 14 days after the baseline assessments. The patient was treated only with colchicine. RESULTS: At baseline, both grayscale and power Doppler sonography revealed clearly evident findings of acute synovitis (joint cavity widening, thickening of periarticular soft tissues and power Doppler signal). After seven days, a complete clinical remission occurred. Ultrasound examination revealed marked improvement with respect to the basic findings, even if all the sonographic features of joint inflammation were still detectable. Two weeks after the onset of the acute attack, clinical remission was maintained and all the sonographic features of synovitis disappeared. CONCLUSION: Sonography is a sensitive and reliable tool for assessing and short-term monitoring of acute gouty attack.
Severe chronic tophaceous gout can be a surgical challenge. A classic case of marked first and fifth metatarsophalangeal joint involvement is presented.
Gouty tenosynovitis may present as infection, tendon rupture, nerve compression and/or digital stiffness. We report a case of tophaceous gout which presented as bilateral carpal tunnel syndrome.
An 82-year-old man developed progressive weakness of both legs 1 month prior to admission. He reported no previous history of trauma. Spine radiography revealed marked thoracic and lumbar spondylosis. Magnetic resonance imaging of the spine disclosed segmental stenosis with cord compression at T10-11 due to an extradural soft tissue lesion. Based on a diagnosis of thoracic spondylosis with cord compression, decompression laminectomy was performed. During the operation, fragile chalky-white material was noted over the epidural space, compressing the thoracic cord. The granular lesion was meticulously removed until the dura was identified and the cord was decompressed. Histologic examination of the surgical specimen revealed deposits of needle-like crystals that were consistent with monosodium urate, demonstrating that a gouty lesion of the thoracic spine had caused the cord compression. The patient had previously experienced several attacks of gouty arthritis of his feet. The postoperative serum uric acid concentration was 8.5 mg/dL. After surgery, he was treated with benzbromarone 100 mg per day. He was able to walk 3 months after the operation. A high index of suspicion of gouty involvement of the spine is necessary in patients with gout. Surgical decompression followed by regular administration of antigout drugs can provide satisfactory results.
The authors try, on one hand, to estimate the role of hyperuricaemia and gout as risk factors in coronary diseases and, on the other, to decide whether the factors react in an isolated or associated fashion.