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The authors (rheumatologists) agree with most recommendations of the Dutch College of General Practitioners' guidelines for the diagnosis and management of gout. The most important criticism concerns the supposed diagnostic value of serum urate levels: close examination of the data suggests that this value is very limited.
The paper presents results of investigations designed to study changes in lipid peroxidation and in antioxidant system of miners in different vocational groups with Reiter's disease and gout. It is shown that the condition of the above systems is affected by both diseases as such and occupational conditions of miners. Based on the secured findings it is recommended that treatment of the above patients be supplemented with an antioxidant agent, copherol in particular.
A clinical evaluation of phenylbutazone and Butapyrin(R) (a mixture of phenylbutazone and aminopyrine) was made in 409 patients who had a variety of rheumatic diseases. Preliminary European claims were substantiated.In gout a specific favorable effect was brought about by phenylbutazone alone. Effects equivalent to the previously reported favorable response to Butapyrin (Irgapyrin) were observed when its constituent phenylbutazone was used alone. The drug had a suppressive effect in a high percentage of patients with rheumatoid arthritis, ankylosing spondylitis, arthritis with psoriasis and mixed arthritis (rheumatoid arthritis plus osteoarthritis). Favorable effect in peritendinitis of the shoulders, osteoporosis of the spine and acute lumbosacral strain also was noted. Toxicity resulted in discontinuance of medication in 10 per cent of patients with each drug. Manifestations of toxicity generally included fluid retention, nausea and rash, but there were several instances of transitory leukopenia and anemia. There was one instance of agranulocytosis with Butapyrin but none with phenylbutazone.dagger Aggravation of peptic ulcer occurred in ten patients with hemorrhage in two. Generally the toxicity was of a low order as compared with that of other drugs having an antirheumatic effect.
Alterations in content of lipid peroxidation products, reactions of generation/interception of superoxide anion radicals, content of R-proteins and uric acid were studied in blood serum of 83 patients with gout depending on the disease activity. Rates of lipid peroxidation, estimated by content of thiobarbituric acid-positive products, and of superoxide anion generation as well as content of R-proteins correlated distinctly with activity of the inflammation. At the same time, content of uric acid in blood serum of these patients correlated reversely with content of the lipid peroxidation products at the disease preexacerbation period, while concentration of these products depended on content of total iron.
Four patients of pure gouty nephropathy are presented. Gout was of over five years duration and asymptomatic nephropathy manifested as non-oliguric acute renal failure. Diseases commonly associated with it like uric acid stones, urinary tract infections, hypertension, diabetes mellitus, hyperlipidemid, obesity and nephrosclerosis were absent. Reduction in serum uric acid level resulted in prompt improvement in renal functions. Early detection and control of hyperuricemia may help in restoration of renal functions.
Diffusely-infiltrating mucinous adenocarcinoma of the renal pelvis associated with lithiasis and chronic gout is reported in a 61-year-old Malay man. The patient underwent left nephrectomy and vesiculo-lithotomy. This tumour is postulated to arise in response to chronic irritation of the urothelium.
A number of investigators have applied the tools of molecular biology to characterize genes responsible for the control of urate homeostasis and clarify the roles of uric acid precursors in inflammation. Some, using the tools of clinical medicine, continue to provide novel descriptions of gout and to explore better ways for evaluating hyperuricemia and for understanding the pathophysiology of disorders such as familial urate nephropathy. Others link the disciplines of basic research and clinical medicine in approaching the perplexing questions of crystal-induced inflammation.
The development of tophi in the absence of prior episodes of gouty arthritis is unusual. We present six such cases and review 26 previously published cases. These patients differ from those with typical gout in that they were older, more likely to be women, and usually had predominant or exclusive finger involvement. Most had renal insufficiency and many were receiving an anti-inflammatory or diuretic. Although several possibilities for the lack of gouty arthritis in the presence of tophi exist, usually no clear explanation is found.
Patients with system lupus erythematosus, rheumatic arthritis, chronic active hepatitis and gout were found to have considerable hyperuricemia and be decreased in aminoacides content, which are the predecessors of purine. Hyperactivity of xanthineoxidase and POL content were also revealed. The close correlation relation of purine indices of such patients has been observed. The obtained data allow applying methods of correction of immunity system and purine metabolism to these patients by introducing in a complex therapy inhibitors of xanthineoxidase.
The osseous metastasis in our patient's first toe has been the initial clinical manifestation of a pulmonary neoplasm and the clinical picture was that of a gout-attack or an other osteoarticular affection. As a rule, primary supradiaphragmatic neoplasia tend to metastasize to the hands whereas primary infradiaphragmatic neoplasia tends to metastasize to the feet. Our patient, who presented a pulmonary tumor with a metastasis in the right foot, did not fit into this schedule.
Hydrocortisone phonophoresis (HPP) on the affected joints or balneotherapy with iodine bromine baths as well as the complex of these two modalities were used to treat 197 patients with osteoarthrosis. Thirty-one of the patients had secondary arthrosis due to recurrent gout attacks. Monotherapy with HPP proved beneficial in affection of 1-2 joints whereas the baths appeared preferable in polyosteoarthrosis, its association with spinal osteoarthrosis, arterial hypertension. Combined application of HPP and the baths produced more pronounced and stable effect with the best relief recorded in polyosteoarthrosis, its progression, secondary synovitis.
An unusual case of a patient with a gouty tophus in the middle ear is presented. The patient had no clinical or laboratory signs of hyperuricaemia. The findings in the middle ear are discussed with reference to current knowledge of the pathogenesis of gout.
Sally Chesson and Sarah Redfern give an overview of the signs, symptoms and nursing care of individuals suffering from gout. Principally a disease affecting men, this condition, extremely painful in the acute stages, is definitively diagnosed by the detection of crystals in joint aspirate. Pain results from the deposition of crystalline sodium urate in the synovial joint but nursing care also requires consideration of associated immobility, anxiety and irritability which the patient may experience.
A 55-year-old man developed acute symptoms suggestive of a late, deep infection 8 years after uncomplicated open reduction and internal fixation of fractures to the left ulnar and radial shafts. At the time of surgical debridement, tophaceous material was found surrounding the radial plate. Acute tophaceous gout surrounding fracture fixation devices has not been previously reported and is difficult to distinguish from a deep infection.
We studied the acute phase response in gout. Oral temperature, white blood cell count and differential, platelet count, Westergren erythrocyte sedimentation rate (ESR), and serum levels of the acute phase reactants serum amyloid A protein (SAA) and C-reactive protein (CRP) were all elevated. The number of involved joints correlated with levels of ESR, SAA and CRP. CRP correlated with temperature, differential count, ESR and SAA. The acute phase response resolved rapidly with treatment.
The clearance of uric acid, hypoxanthine and xanthine has been examined in gouty patients and in normal subjects comparatively to the creatinine clearance. The clearance of the three purine compounds was lower in the gouty patients, while the creatinine clearance showed a normal behavior. These results indicate that either the tubular excretion or the carriers of the considered metabolites probably undergo specific alterations in the gout.
The authors studied the arthroscopic picture of the knee joint in 50 male patients, 40 of whom had a genuine gout and 10 a doubtful one. A high diagnostic significance of arthroscopy was emphasized, it rose with the use of a morphological analysis of samples of synovial membrane and villi obtained by means of target biopsy, microscopy and chemical identification of urate.
As many as 8 families suffering from gout were examined with the use of four tests for the repair of DNA damages. The criteria applied for the assessment of the reparative activity made it possible to identify in total or in different combinations the inhibition of the repair in the lymphocytes of all the probands examined. The use of 1-3 procedures revealed the repair defects in all the families, namely in the lymphocytes of the probands' relatives. Based on this fact an attempt has been made to identify possible carriership of the "pathological" genes in the proband's relatives, which in future will make it possible to develop approaches to the identification of the genetic markers of the disease as well as to the disease prevention.