ABSTRACT
Objective: The study aim is to present the clinical, radiological aspects and treatment of this disease from the neurosurgical standpoint using a literature review and an illustrative case. Methods: A PubMed research was done with the terms ?tophaceous gout?, ?spine?, and ?diagnosis?. We reviewed these articles and compared it with an illustrative case here presented. Results: According to a research done, this is the fifty-second case of tophaceous gout of the spine described in the English literature. The case and literature review presented demonstrate the difficulty in diagnosis, especially when the patient has no previous history of gout. Conclusion: It is important to consider tophaceous gout of the spine among the differential diagnoses that occur in the spine. Clinical and neurosurgical treatment may be required considering each case...
Objetivo: O objetivo deste estudo é apresentar a clínica, os aspectos radiológicos e o tratamento dessa afecção do ponto de vista neurocirúrgico, utilizando uma revisão da literatura e um caso ilustrativo. Métodos: Foi realizada uma pesquisa no PubMed com os termos ?tophaceous gout?, ?spine?, e ?diagnosis?. Analisamos os artigos e comparamos com um caso ilustrativo aqui apresentado. Resultados: De acordo com pesquisa realizada, este é o 52º caso de tofo gotoso de coluna vertebral descrito na literatura. O caso ilustrativo e a revisão de literatura aqui apresentados demonstram a dificuldade no diagnóstico, especialmente quando o paciente não tem história prévia de gota. Conclusão: É importante levar em consideração o tofo gotoso de coluna entre os diagnósticos diferenciais de doenças que acometem a coluna vertebral. Tratamentos clínicos e neurocirúrgicos podem ser necessários considerando cada caso...
Subject(s)
Humans , Male , Middle Aged , Arthritis, Gouty/surgery , Arthritis, Gouty/diagnosis , SpineABSTRACT
objective The roles of TLRs and their signal pathway in gouty arthritis(GA)were explored.Methods TLR2 and TLR4 mRNA was measured using real-time quantitative polymerase chain reaction(RT-PCR)in PBMCs,IL-1β level was detected using ELISA in plasma,and NF-κB p65 protein level in PBMCs was measured using Western blot.Level of TLR2 mRNA,ILR4 mRNA,IL-1β,NF-κB p65protein was compared among acute GA,non-acute GA and healthy controls.Correlation between TLR2mRNA,TLR4 mRNA and serum uric acid,IL-1β level in GA patients was analyzed.One-way ANOVA was used to analyze data between multiple groups and q-test was used for two-two comparison.Spearman's analysis was applied for correlation analysis.Resuits The expression of TLR4 mRNA,NF-KB p65 protein,IL-1β arid serum uric acid level in patients with acute GA [(5.0±1.2), (7.11±0.18), (283±83)pg/ml,[585±123)μmol/L] was significantly increased compared to non-acute GA[(2.3±0.4),(0.63±0.06),(134±29)pg/ml,(493±107)μmol/Lj and healthy controls(1.1±0.6),(0.52±0.12),(97±17)pg/ml,(326±65)μmol/L](P<0.01,respectively).Significant diffefence was also observed between non-acute GA patients and healthy controls(P<0.05,respectively).The level of TLRR4 mRNA was positively correlated with uric acid and IL-1β level in GA patients(rs=0.876,0.779;P<0.05,respectively).Conclusion Innate immunity are activated by membrane-type pattern recognition receptors in primary GA.TLR4-NFκB p65-IL-1β signat transduction may participate in the inflammatory mechanisms of gout.Urate crystals in patients with gout may:be involved in the activation of TLR4 and its signal pathway.
ABSTRACT
Objective To investigate the role of malondialdehyde(MDA),superoxide dismutase(SOD),and interleukin-1β (IL-1β) played in the pathogenesis of acute gouty arthritis and the treatment efficacy of probucol.Methods Acute gouty arthritis model in rat was established with injection of monosodium urate monohydrate (MSU) into the ankle joint cavity,then the joint swelling index was observed periodically,and MDA,SOD,IL-1β,and white blood cell count in the synovial fluid were determined by 72 h.Results The joint swelling index gradually increased,reaching a peak by 11h,and this finding was most obvious in the model group.The joint swelling index in the group treated with high-dose of probucol was significantly lower than that in the model group by 48 h(P＜0.05).The joint swelling indices in the groups treated with moderate and high doses of probucol were lower than that in the model group by 72 h(P＜0.05).The values of MDA in the moderate and high-dose groups were (14.45±3.11) and (11.54 ±3.10) nmol/ml respectively,being significantly lower than that in the model group[(24.46±4.27) nmol/ml,P＜0.01].The amounts of SOD in the moderate and high-dose groups were (25.56±4.51) and (44.61±4.11)U/ml respectively,being higher than that in the model group[(13.32±2.02) U/ml,P＜0.01].The amount of IL-1β in the high-dose group was lower than that in the model group[(15.41 ± 3.12 vs 19.87±3.99)pg,P＜0.05].The white blood cell counts in the moderate and high-dose groups were (11.08±1.64)×l0~7/L and (7.43±1.52) x 10~7/L,being lower than that in the model group[(14.18±2.30)×10~7/L,P＜0.01].Conclusion The levels of MDA and IL-1β in the synovial fluid were raised,while SOD was significantly decreased in acute gouty arthritis.Moderate and high-doses of probucol can effectively control acute gouty arthritis attack.The efficacy of high-dose probucol was equal to that of colchicines.