Analysis of risk factors influencing the detection rate of urate crystal by dual energy computed tomography / 北京大学学报(医学版)

OBJECTIVE@#To explore the risk factors of detection of uric acid crystals by dual energy CT (DECT) in patients with gout diagnosed by gold standard.@*METHODS@#From June 2011 to December 2018, clinical data of 29 patients were collected who were diagnosed with acute or chronic gout by positive polarized light analysis of joint synovial fluid in First Hospital of Peking University. Chi-square test, Logistic regression and t-test were used. The relationship between DECT and the clinical data, laboratory examination and drug treatment were analyzed.@*RESULTS@#In this study, 29 patients were included, of whom, 22 patients were detected with uric acid crystals by DECT, and 7 patients were not. According to whether the uric acid crystals were detected or not by DECT, the patients were divided into two groups. Compared with the negative group, the patients were older in positive group [(47±12) vs. (39±11) years, P=0.15], had higher body bass index (BMI) [(27.9±3.7) vs. (22.8±2.1) kg/m2, P=0.002], longer gout disease duration [(135±102) vs.(45±53) months, P=0.035], higher in the highest serum uric acid in history [(643±121) vs. (543±103) μmol/L, P=0.043]. Although uric acid near DECT in positive group was higher than in negative group, there was no statistical difference [(558±150) vs. (513±89) μmol/L, P=0.497]. Comparing positive group with negative group, the percentage of the patients in acute phase was higher than in chronic phase [18(81.8%) vs. 4(57%), P=0.311];the percentage of the patients taking uric-acid-lowering drugs was higher than the other group [22(100%) vs. 5 (71%), P=0.052];the percentage of the patients with recurrent typical attacks was higher than that of those without typical attacks [22 (100%) vs.6 (85%), P=0.241]. The consistency of symptoms and the finding of uric acid crystals by DECT had been compared between the joints. The right knee joint had the highest consistency (Kappa=0.627), followed by the left MTP1 (Kappa=0.58), the right metatarsophalangeal 1(MTP1, Kappa=0.551) and the left knee (Kappa=0.494), all of which had statistical significance. The consistency of the ankle joint was lower (the right ankle joint: Kappa=0.19, the left ankle joint: Kappa=0.256), showing no statistical significance. BMI (kg/m2) [2.307 (1.139-4.670), P=0.02], gout duration (years) [0.306 (0.906-4.881), P=0.186], and the highest uric acid level in history (mg/dL) [0.023 (0.981-2.764), P=0.137] had relationship to the positive result of urate crystals in DECT.@*CONCLUSION@#Gout patients with larger BMI, higher previous highest uric acid value and longer gout duration had higher sensitivity of the positive result in DECT.

Critical revision of the medical treatment of gout in Brazil / Revisão crítica do tratamento medicamentoso da gota no Brasil

ABSTRACT Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems.

RESUMO A gota é considerada a forma mais comum de artrite inflamatória em homens acima de 40 anos. Os autores apresentam uma breve revisão sobre o tratamento atual da gota e discutem as limitações farmacológicas existentes no Brasil para o tratamento dessa enfermidade. Apesar de o alopurinol ainda ser a principal medicação para a redução dos níveis de uricemia de pacientes com gota no país, os autores também apresentam dados que apontam para uma grande oportunidade para o mercado farmacológico brasileiro em relação ao tratamento da hiperuricemia e da artrite gotosa e especialmente para pacientes usuários de sistemas privados de saúde e do SUS (Sistema Único de Saúde).

Principales enfermedades reumáticas en México: aspectos epidemiológicos e impacto socioeconómico / Principal rheumatic diseases in Mexico: epidemiological aspects and socioeconomic impact

Objetivo. Conocer las características epidemiológicas y demográfias de aquellos pacientes que acuden a la práctica privada e institucional de la reumatología en la república mexicana. Método. Se efectuó una revisión bibliográfica formal, principalmente de revistas médicas mexicanas, de las que las tres cuartas partes fueron publicaciones aparecidas en la RevistaMexicana de Reumatología. Resultados. Los resultados pueden considerarse como una muy importante contribución al conocimiento de algunos hechos acerca de los enfermos que acuden a la consulta reumatológica privada e institucional en diversas muestras de población de México país. Conclusiones. Entre las enfermedades reumáticas más comunes en México, hay cierto predominio del sexo femenino y es también evidente la tendencia a la cronicidad; se informan y comentan algunos otros aspectos sobresalientes.

Nodulosis gotosa: una entidad nodulosa o patológica?

Los nódulos subcutáneos están presentes en múltiples enfermedades sistémicas incluyendo lupus eritematoso sistémico, fiebre reumática, artritis reumatoidea y gota. Llamamos la atención sobre aquellos pacientes con tofos subcutáneos múltiples por depósito de urato monosódico sin historia de artritis gotosa. Presentamos un caso de un hombre con presencia de nódulos subcutáneos indoloros de seis años de evolución en carpos, metacarpofalángicas, interfalángicas proximales, codos y rodillas, sin antecedentes de artritis. Planteamos la existencia de un subgrupo clínico de pacientes con gota, cuyo curso es más benigno con respecto al compromiso articular y se proponen sus criterios clínicos

Gota úrica: consideraçöes estatísticas em nosso meio - estudo de 101 casos / Uric gout: statistical consideration in our environment - study of 101 cases

Os autores apresentam 101 casos de gota úrica em pacientes atendidos em Serviços Ambulatorial de Reumatologia na cidade de Joao Pessoa-PB no Hospital Lauro Wanderley UFPB e clínica privada, no período de 1978 a 1993. Após a identificaçao dos casos, é realizado levantamento de dados referentes a: idade, sexo, profissao, consrtituiçao física, formas de apresentaçao, articulaçoes acometidas, associaçoes com outras patologias e evoluçao. Por último fazem correlaçao com estatísticas mundiais, quando é observado semelhança com as informaçoes encontradas.

Alcoolismo, hiperuricemia e gota / Alcoholism, hyperuricemia and gout

Os autores determinaram a ocorrência de hiperuricemia e gota em uma populaçäo de alcoólatras internados em hospital especializado da cidade de Uberaba, MG. A dosagem do ácido úrico foi feita de quatro dias a uma semana após a última ingestäo de bebida alcoólica. Compararam os resultados obtidos com aqueles de um grupo controle. Concluem que em sua amostra näo ocorreu hiperuricemia, como também foi baixa a prevalência de gota na populaçäo estudada

Gota en el anciano / Gout in the elderly / Gout in the elderly

Los libros de texto y la literatura reumatologica en general, hacen hincapie en la presentacion clinica clasica del paciente con gota y en su tratamiento medico. Con frecuencia, sin embargo, la presentacion no es tipica en el anciano y el diagnostico pasa desapercibido o se establece en forma erronea. En las mujeres de 60 anos la presentacion de la gota puede ser poliarticular, de iniciacion lenta, no aguda, y con compromiso de articulaciones pequenas de las manos, dando lugar a confusion con una posible artritis reumatoidea o con la exacerbacion de un proceso degenerativo. El examen cuidadoso del liquido sinovial y la identificacion de los cristales de urato monosodico son primordiales para el diagnostico. Es preciso conocer las interacciones farmacodinamicas de las medicaciones antiinflamatorias e hipouricemiantes con otras que el paciente pueda estar tomando para procesos asociados. El medico debe abstenerse de tratar la hiperuricemia asintomatica. Una vez confirmado el diagnostico de gota debe trazarse un plan de tratamiento y seguimiento. Las reacciones severas a los antiinflamatorios no esteroideos, a la colchicina y al alopurinol son mas frecuentes en el anciano.

Textbooks and general rheumatologic literature emphasize the classic clinical presentation of the patient with gout as well as his or her treatment. Quite often however, this presentation does not occur in the elderly patient or the diagnosis is missed or Is erroneously formulated. In women 60 years of age and older, gout can be polyarticular, can have an insidious, nonacute onset and may Involve the small joints of the hands, all of which may lead to diagnose rheumatoid or degenerative arthritis. Careful examination of synovial fluid along with identification of monosodium urate crystals are mandatory for an accurate diagnosis of gout. Possible drug interactions between anti-inflammatory and hypouricemic drugs with other medications have to be kept in mind. Asymptomatic hyperuricemia should not be treated. Once the diagnosis of gout is confirmed a strict follow-up is required to detect the frequent side effects of non- steroid anti-inflammatory drugs, colchicines and allopurinol that tend to take place in the elderly patients.

Gota / Gout

Se realizó un trabajo retrospectivo estudiando las características clínicas, de laboratorio, evolución y supervivencia de 31 pacientes diagnosticados de Gota entre los años 1969 y 1986 en el Hospital Cayetano Heredia. La edad promedio fue de 52 años, siendo el 97% de sexo masculino. Todos tuvieron historia de artritis'81%tuvieron niveles elevados de ácido úrico y 74% presentaron disminución de la Depuración de Creatinina. El perfil clínico de la enfermedad demostró semejanzas con lo decrito en la literatura. Se demostró una relación una relación entre la presencia de Urolitiasis y los niveles de ácido úrico urinario. Igualmente se observó una supervivencia del 85% a los 6 meses de seguimiento entre los hallazgos más resaltantes