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[Venous participation in gonarthrosis, rheumatoid arthritis, and gout].

The authors describe three major rheumatological classifications together with an account of the phlebological aspects of these phenomena. They deal with gonarthrocace, which is predominantly stasis; rheumatoid arthritis, which may be induced by inflammatory injuries to the vein wall, by endothelitis of the venulo-capillary segments, or racemose lividity; and gout which mainly involves turgescence, and mural phlebitis. This is not forgetting the secondary classifications, associated with polyglobulism, anemia, and foranioplasia.

Arthritis, Rheumatoid↗

Bone ankylosis. a rare manifestation of gout.

A 44 year old man with neglected tophaceous gout developed progressive bony and fibrous ankylosis of the lower leg articulations extending from a toe through the ankle, in spite of three years of otherwise successful therapy.

Aged↗

[The frequency of gout and other disorders of uric acid metabolism in Dalmatia in comparison with these disorders in Croatia].

According to the literature gout is more frequent in Dalmatia than in continental part of Croatia. Higher average values of uric acid in serum, prevalence of hyperuicaemia as well as uric nephrolithiasis are also seen more frequently in Dalmatia comparing to the continental Croatia. This is probably genetically determined and is connected with metabolic changes of uric acid. Relative isolation of population in Dalmatian where the part of immigrants from other regions since the war started was very small favoured these changes. In addition some exogenous factors contribute in clinical manifestation of uric acid metabolic disturbances. The most important among them are consumption of food rich in nucleoproteins and dehydration in summer period.

Croatia↗

Gout with aseptic loosening of cementless total hip arthroplasty--a case report.

One case of gouty patient with aseptic loosening of cementless total hip arthroplasty was reported. Mechanical and biological factors may both play some roles in this ollsening hip. From both cup and stem, no direct evidence of loosening was found from pathologic aspect. Further study may need to define relationship between gout and loosening of total hip arthroplasty.

Aged↗

Gout arthropathy: description of an atypical case.

The authors describe a case of gout localized in the knee, the clinical and radiographic signs of which may lead to numerous diagnostic interpretations. Other affections with which differential diagnosis is difficult are reported, and principal diagnostic tests are described.

Adult↗

Withdrawal of longterm antihyperuricemic therapy in tophaceous gout.

OBJECTIVE: To determine the effect of withdrawal of antihyperuricemic therapy on the recurrence of tophi and acute arthritis. METHODS: We performed a retrospective investigation of 21 patients with tophaceous gout who stopped therapy because they had no arthritis for years, and on examination tophi had disappeared. RESULTS: Nine patients (43%) had a recurrence of tophi after an average period of 39.6 months (range 4-107 months). Seventeen patients (81%) had attacks of acute arthritis, 6 patients within 6 months. During a mean period of drug discontinuation of 37.6 months no increase in serum creatinine or deterioration in joint function was observed. CONCLUSION: Based on our data we conclude that intermittent usage of antihyperuricemic drugs will, after a variable period, result in the frequent recurrence of acute arthritis and tophi.

Adult↗

Gout: an experience from Zimbabwe.

Twenty three patients with gout treated and followed up in Zimbabwe over a five year period were analysed. Men were afflicted 6.7 times more than women. Their mean age at diagnosis was 44 +/- 8 years and the mean serum uric acid level was 588 +/- 138 mumol/l. The disease was diagnosed late with 30.4 pc of all patients presenting with tophi. Associated alcohol excess was universal and the shoulder, a proximal big joint, was also affected in 21.7 pc of all patients. There is a need for serum uric acid levels for the different localities in Africa to be mapped out and alcohol excess to be curtailed.

Adult↗

Gout and 'pseudogout'. When are arthritic symptoms caused by crystal deposition?

The proper diagnosis of gout and pseudogout (ie, calcium pyrophosphate dihydrate crystal deposition disease) leads to correct treatment. The two disorders can be easily confused and misdiagnosed in certain situations. Thus, in every case, synovial fluid aspiration and microscopic synovial fluid analysis under compensated polarized light should be done to confirm the suspicion of crystal-induced arthropathy. Underlying diseases should always be sought, because many are treatable.

Calcium Pyrophosphate↗

Preventing acute gout when starting allopurinol therapy. Colchicine or NSAIDs?

Acute gout is a well known complication of the commencement of allopurinol therapy. Prophylaxis is needed for some months, even after serum urate levels have returned to normal. Colchicine is usually preferable to NSAIDs for this purpose, being cheaper, and better tolerated, especially in patients with peptic ulcer, gastrointestinal bleeding or dyspepsia or who are taking anticoagulants.

Acute Disease↗

Consecutive stages of arthropathy progression in patients with gout.

During observation of 250 patients with gout in the Institute of Rheumatology in Warsaw in the years 1962-1975 several patterns of joint destruction stages in gouty arthropathy have been recognized on the basis of serial roentgenograms. Histological examination of joints and bones suggests with a considerable probability that the progression of arthropathy depends on the extension of sodium urate deposits in articular tissues. Histological documentation of consecutive stages of joint distruction corresponding to the above mentioned patterns of radiological changes is presented.

Gout↗

Xanthinuria : study of a large kindred with familial urolithiasis and gout.

We have carried out biochemical and clinical studies on a large family in which xanthinuria, xanthine lithiasis, uric acid lithiasis and/or gout were discovered. The analysis of its pedigree has shown that : a) the mode of transmission of xanthinuria is autosomal recessive; b) the occurence of xanthine urolithiasis is likely to be due to the association of a second genetic disorder.

Female↗

Concentrations of adenine nucleotides in erythrocytes of patients with gout.

Gout has long been known as a disease of the high social class or of those with achieved social status. Brooks and Mueller (1966) studied the relationships between behavior and serum uric acid levels among university professors. They indicated that personal characteristics of drive, achievement, and leadership are positively associated with the uric acid levels in plasma. Hansen and Dimitrakondi (1974) reported a marked decrease in ATP levels in psychotic depression and significant correlation between ATP concentration and mood scores. We estimated the adenine nucleotides in erythrocytes of gouty patients.

Adenine Nucleotides↗

Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR features.

We present the MR findings in a case of tophaceous gout of the lumbar spine with cauda equina compression, mimicking an epidural abscess. The diagnosis was clinically unsuspected and confirmed at laminectomy. Tophus material in the paraspinal soft tissues appeared intermediate in signal intensity and showed heterogeneous contrast enhancement.

Abscess↗

Female premenopausal tophaceous gout induced by long-term diuretic abuse.

We describe 3 cases of tophaceous gout affecting premenopausal women. The only precipitating factor to be found was the chronic and unnecessary overuse of furosemide, apparently resulting from a psychological profile of anorexia nervosa. Our cases emphasize the need for physicians to look for hidden abuse of diuretics in the presence of gouty arthritis in menstruating women, especially if tophi are noted.

Adult↗

Prepatellar bursitis: a unique presentation of tophaceous gout in an normouricemic patient.

We describe a patient with no history of gout and persistently normal serum uric acid concentrations in whom septic acute prepatellar bursitis was diagnosed initially, but empiric antibiotic therapy failed. Urate crystals were detected when the prepatellar bursa was aspirated for the 3rd time, and the diagnosis was changed to gouty bursitis. The case illustrates the importance of repeatedly aspirating suspicious sites to establish the diagnosis in elusive cases of crystal deposition disease.

Aged↗

Noninflammatory phagocytosis of monosodium urate monohydrate crystals by mouse macrophages. Implications for the control of joint inflammation in gout.

OBJECTIVE: We have hypothesized that the process of monocyte to macrophage differentiation may alter the inflammatory response of mononuclear phagocytes to the uptake of monosodium urate monohydrate (MSU) crystals. METHODS: Eight mouse monocyte/macrophage cell lines were arranged in increasing order of differentiation, as judged by expression of the macrophage markers F4/80 and BM 8 and by phagocytic capacity. Secretion of tumor necrosis factor alpha (TNFalpha) in response to MSU was measured by enzyme-linked immunosorbent assay. RESULTS: The panel of monocyte/macrophage cell lines revealed a close linkage between the state of differentiation and the capacity of the cells to ingest MSU crystals. TNFalpha production, however, was not linked to phagocytic ability. Peak TNFalpha levels were synthesized by cells at an intermediate state of differentiation (3.2-14.1 ng/ml), whereas mature macrophages, which efficiently phagocytosed crystals, did not secrete TNFalpha. Mature cell lines produced TNFalpha when stimulated with zymosan (5.9-6.2 ng/ml), but this was abolished by coincubation with MSU crystals. Suppression of the zymosan response was not due to apoptosis or steric hindrance by MSU crystals. Culture supernatants from mature macrophages did not stimulate endothelial cell activation, in contrast to MSU-treated cells at an earlier stage of differentiation, which stimulated intercellular adhesion molecule 1 expression on sEND endothelioma cells through the release of TNFalpha (inhibited 80.6% by anti-TNFa). CONCLUSION: We demonstrated that phagocytosis and TNFalpha production are distinct events in the response of mononuclear phagocytes to urate crystals, and these events can be distinguished at the level of macrophage differentiation. The noninflammatory removal of urate crystals by mature macrophages defines a new pathway that may be important in controlling the development of acute gout in patients with hyperuricemia.

Animals↗

Isolated intraosseous gout in hallux sesamoid mimicking a bone tumor in a teenaged patient.

We are reporting an unusual case of isolated intraosseous tophus in medial hallux sesamoid presenting as tumor-like lesion in a teenage patient without prior history of gouty attack and underlying systemic disorders. The lesion manifested isointensity to surrounding muscles with internal low signal on spin echo (SE) T1-weighted images, and heterogeneous low signal intensity on fast spin echo (FSE) T2-weighted images. Computed tomography (CT) scan disclosed expansion and diffusely increased attenuation of the medial hallux sesamoid with focal cortical erosion and extraosseous extension of high attenuation content. The subsequent resection and pathology revealed intraosseous tophus deposition, which is particularly rare at this site and at this age. Imaging studies revealed some characteristic imaging features which can retrospectively be attributed to gouty tophus. When an expansile osteolytic lesion manifesting low signal intensity on T2-weighted image and internal calcifications on CT scan is encountered, the possibility of intraosseous tophus should be included in the list of differential diagnoses, even in a teenage patient without prior history of gout.

Adult↗

[Mixed tophi. Calcium pyrophosphate dihydrate crystals in gout tophi].

Calcification of tophi is a well-known secondary phenomenon in gout. Because there are no data available on the nature of the calcium component, light and scanning electron microscopic as well as X-ray microanalysis studies were performed on calcified tophi. In unstained histological slides, urate crystals were detected as negative birefringent needles; after incubation of the slides in distilled water, the urate crystals had disappeared, only positive birefringent calcium pyrophosphate dihydrate (CPPD) crystals of different size remained. An identical result was obtained by scanning electron microscopy. By X-ray microanalysis, peaks for calcium and phosphorus were measured, indicating the presence of CPPD. The occurrence of CPPD crystals in urate tophi as well as in foreign body granulomata indicates that the occurrence of CPPD is not restricted to articular tissues. The biochemical mechanism leading to the appearance of these crystals remains unknown, but it may be assumed that an increase of connective tissue destruction may be responsible for this calcification process.

Adult↗