Periprosthetic gout flare after total knee arthroplasty: A misdiagnostic case report / 北京大学学报(医学版)

Periprosthetic gout flare is a rare arthritic condition after total knee arthroplasty, but the symptoms of gout may have often been mistaken as acute periprosthetic infection given their similarity. Misdiagnosis as periprosthetic infection can lead to unnecessary surgery, long-term dependence on anti-biotics, and even malfunction of the involved knee joint. Here, we report a case study of a patient with immunodeficiency condition of long-term oral glucocorticoid and diabetes mellitus, who had undergone a knee replacement 8 weeks before. The initial symptoms of fever and joint pain together with the dysfunction of her right knee with elevated inflammatory markers, such as increased serum leukocytes, erythrocyte sedimentation rate, C-reactive protein, and synovial cell counts led to a diagnosis of acute periprosthetic infection. Arthrocentesis and bacterial culture were performed preoperatively. According to the current Musculoskeletal Infection Society (MSIS) criteria for diagnosis of periprosthetic infection, the case was classified as periprosthetic infection and a prosthesis retained debridement surgery was performed. However we got negative culture results in all the pre-operative and intro-operative samples. The symptoms as well as the laboratory inflammatory markers improved shortly after the debridement surgery until the 11th day when all the similar systemic and local symptoms recurred. With a remedial crystal analysis of synovial fluid from the patient, gouty flare was found to be the cause of acute arthritis finally. Accor-dingly, after anti-gout medications were administrated, the symptoms associated with acute arthritis gra- dually subsided, and there was no recurrence during a 24-month follow-up. This article described the cli-nical manifestation, diagnosis and differential diagnosis, treatment of a case of periprosthetic gout. Although relatively rare, gout should be considered as a differential diagnosis in suspected periprosthetic infection. Current criteria for periprosthetic infection can not exclude the diagnosis of periprosthetic gout flare, it is therefore imperative that the analysis of joint aspirate for crystals be conducted to determine the correct course of treatment, or unnecessary surgical procedure may be performed in periprosthetic gout case.

La gota como factor de riesgo cardiovascular / Gout as a cardiovascular risk factor

Introducción: La gota es una enfermedad inflamatoria crónica que generalmente cursa con hiperuricemia sobre añadida. Objetivo: Identificar la presencia de afectación cardiovascular en pacientes con diagnóstico confirmado de artropatía gotosa. Metodología: Investigación básica, no experimental, descriptiva, retrospectiva y con enfoque mixto. El universo estuvo constituido por 69 pacientes atendidos en unidades del primer nivel de atención de salud de la ciudad de Riobamba durante el periodo comprendido entre enero de 2019 y enero de 2021. La muestra quedó conformada por un total de 60 pacientes. Se realizó revisión de la historia clínica de los pacientes para obtener la información necesaria. Resultado: Promedio de edad de 53,02 años. El 35,00 por ciento de ellos presentó al menos una comorbilidad asociada, y la diabetes mellitus fue la más representada (57,14 por ciento). El 71,67 por ciento de los pacientes tenía valores normales de ácido úrico en sangre en el momento del diagnóstico y el 18,33 por ciento presentaba algún tipo de daño renal. El 36,67 por ciento de los pacientes con gota también padecían afección cardiovascular; la hipertensión arterial (59,09 por ciento) fue la más frecuentemente reportada. Conclusiones: La artropatía gotosa es una enfermedad que genera un elevado porciento de afecciones cardiovasculares dentro de las que destacan la hipertensión arterial y la insuficiencia cardiaca(AU)

Introduction: Gout is a chronic inflammatory disease that generally progresses with added hyperuricemia. Objective: To identify the presence of cardiovascular involvement in patients with a confirmed diagnosis of gouty arthropathy. Methodology: A basic, non-experimental, descriptive, retrospective and mixed-focus research was developed. The universe consisted of 69 patients treated in first-level health care units in the city of Riobamba during the period between January 2019 and January 2021. The sample was made up of a total of 60 patients. A review of the clinical history of the patients was carried out to obtain the necessary information. Result: Average age of 53.02 years. 35.00 percent of them presented at least one associated comorbidity, where diabetes mellitus was the most represented (57.14 percent). with presence of comorbidities. 71.67 percent of the patients had normal blood uric acid values at the time of diagnosis and 18.33 percent had some type of kidney damage. 36.67 percent of the patients with gout also presented cardiovascular disease, where arterial hypertension (59.09 percent) was the most frequently reported. Conclusions: Gouty arthropathy is a disease that theoretically generates a high percentage of cardiovascular diseases within of which arterial hypertension and heart failure stand out(AU)

Male fertility potential alteration in rheumatic diseases: a systematic review

ABSTRACT Background Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility. Materials and Methods A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behçet disease and gout. Two independent researchers carried out the search in online databases. Results A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behçet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behçet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies. Conclusions Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.

Carpal tunnel syndrome caused by tophaceous gout

No abstract available.

Serum Cystatin C is a Potential Endogenous Marker for the Estimation of Renal Function in Male Gout Patients with Renal Impairment

Serum creatinine level is the most commonly used indices for assessment of glomerular filtration rate (GFR), even though these indices have been shown to have some limitations in clinical practice. We investigated the diagnostic efficacy of serum cystatin C compared to that of serum creatinine levels and identified the relating factors associated with changes in serum cystatin C levels in gout patients with renal impairment. A total of 68 gouty patients with renal impairment were enrolled in this study. Diagnostic efficacy of serum cystatin C levels was evaluated through non-parametric receiver operating characteristic (ROC) analysis. The risk factors for changes in serum cystatin C levels were confirmed using multivariate regression analysis. With 24-hr urine creatinine clearance (Ccr) as the reference for GFR, 1/cystatin C (r=0.702, P<0.001) showed a significantly higher correlation with Ccr than 1/creatinine (r=0.665, P<0.001). Multivariate correlation analysis demonstrated that the clinical parameters for increased serum cystatin C are a higher stage of chronic kidney disease, older age, use of allopurinol, and lower high density lipoprotein-cholesterol. The area under the curve (AUC) at ROC plots identified that of serum cystatin C was significantly greater than that of serum creatinine (AUC 0.804 of cystatin C and AUC 0.745 of creatinine). The study suggests that serum cystatin C is a reliable endogenous marker for the assessment of renal function or GFR in gout patients with renal impairment.

The Prevalence of Metabolic Syndrome in Patients with Gout: A Multicenter Study

It has been suggested that hyperuricemia and possibly gout are associated with the metabolic syndrome, but there have been no direct studies. This study was undertaken to obtain the prevalence of the metabolic syndrome in patients with gout and to compare it with those from the general population studies. This was a 4-institutional case-historical control study composed of 168 patients with gout. We assessed the prevalence of metabolic syndrome according to the ATP III criteria and compared the prevalence with that of the historical controls. To elucidate the factors in gout that were associated with metabolic syndrome, a multivariate analysis was done. The age-adjusted prevalence of metabolic syndrome in gout patients was 43.6%, which was significantly higher than that of the Korean control population (5.2%) from the previous studies. Patients with gout had more components of metabolic syndrome than did the controls. Body mass index (BMI, OR=1.357 (95%CI 1.111-1.657)) and high density lipoprotein (HDL, OR=0.774 (95%CI 0.705-0.850)) were the variables most significantly associated with the occurrence of metabolic syndrome in gout, but alcohol consumption did not show such associations. Gout is associated with the metabolic syndrome, and furthermore, obesity and dyslipidemia were the factors most associated with the syndrome in these patients.

Concomitant gout and rheumatoid arthritis--a case report.

We report a case of definite rheumatoid arthritis and co-existing gout. Although gout and rheumatoid arthritis are relatively common entities individually, the co-existence of these two conditions is rare.

Gota familiar y nefropatía en una mujer joven: caso clínico / Familial gout and nephropathy in a young woman: clinical case

We report a 29 years old woman with a chronic tophaceous gout, whose disease started at the age of 18. On clinical examination, the blood pressure was elevated. The laboratory assessment showed a serum uric acid of 15 mg/dl, a urinary uric acid of 155 mg/24 h, a creatinine clearance of 59 ml/min/1.73 m2 and a uric acid excretion fraction off 1.3 per cent (normal 7 to 12 per cent). The clinical and laboratory features of this patient suggest the diagnosis of a familial juvenile gouty nephropathy

Lipomatose simétrica múltipla / Multiple symmetric lipomatosis

Relata-se um caso de Lipomatose Simétrica Múltipla (LSM) com as características clínicas da variante tipo II, associada a alcoolismo, hipertensäo arterial sistêmica, gota e hipotireoidismo. O paciente apresenta ainda, insuficiência renal crônica (provável nefroesclerose hipertensiva), úlcera de perna (hipertensiva), insuficiência vascular periférica, sintomas näo relacionados até entäo com a LSM.

Tophaceous gout: a case of bilateral carpal tunnel syndrome

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.

Gota: estudio descriptivo en el Estado de Sonora (México) / Gout: Descriptive study in Sonora (Mexico)

Objetivo. La gota es una enfermedad común en México, que muchas veces la vemos poliarticular y erosiva. Se informan las características clínicas de un grupo de pacientes residentes en el Estado de Sonora (México), determinando si son sobreproductores o hipoexcretores y si el diagnóstico había sido correcto antes de la consulta de Reumatología, siguiendo los criterios del Colegio Americano de Reumatología. Resultado: Se reunieron 72 (68 hombres y 4 mujeres), con edades de 26 a 69 años (media 49.3), evolución de 1 semana a 20 años (mediana 30 meses), 40 con hábitos de alcoholismo de intensidad diversa, 12 tomaban furosemida, 48 obesos, 20 con hipercolesterolemia y 24 con hipertrigliceridemia; 28 hipertensos, 3 diabéticos y 4 en insuficiencia renal. El cuadro fue poliarticular en 60, 44 tenían erosiones y el diagnóstico previo fue correcto en sólo 16 pacientes. 32 eran hipoexcretores, 24 sobreproductores y 16 con mecanismo mixto. Conclusión. Nuestra población es diferente a la informada en la literatura: 90 a 95 por ciento son hipoexcretores en contraste con y 44 por ciento en nuestra serie. La ingestión de alcohol fue el factor precipitante en más de la mitad de los pacientes. Se necesita difundir el conocimiento del cuadro clínico de esta enfermedad, que aunque comúnmente es mono u oligoarticular, la mayoría presentaron cuadro apoliarticular, con erosiones y sin diagnóstico antes de la consulta especializada

Tofo gotoso / Thophaceous gout

Apresentamos um caso clínico de gota com tofos gotosos exuberantes, de localizaçäo habitual e lesöes incomuns do tipo pustulosas nas palmas das mäos que também continham cristais de monourato de sódio. Atualmente estes casos näo säo frequentes devido ao diagnóstico precoce e tratamento eficaz da doença.

Colchicine-induced myopathy in renal failure.

A 60 year-old woman with chronic renal failure developed acute proximal muscle weakness after receiving a regular dosage of colchicine. Elevation of muscle enzymes and electromyography were compatible with myopathy. Muscle biopsy revealed variation in muscle fiber size and few vacuolated fibers which were features of colchicine-induced myopathy. The clinical improvement and decreasing in muscle enzyme level occurred after colchicine withdrawal. Other potential causes of myopathy such as chronic renal failure and other drugs were ruled out. We suggested that colchicine should be used with caution in the presence of renal failure especially when other drugs which affect the metabolism of colchicine are also prescribed.

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

Non-oliguric acute renal failure in gout.

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.

Seudopodagra, presentación de cuatro casos y revisión de la literatura

Se presentan cuatro casos de mujeres jóvenes con cuadro clínico de inflamación aguda de la primera articulación metatarsofalángica y a quienes se les demostró en los rayos X calcificaciones a ese nivel. Consideramos que se trata de los primeros cuatro casos de suedopodagra por hidroxiapatita descritos en Colombia. Se hace una descripción yel diagnóstico diferencial de esta entidad

Gota: una revisión clínica / Gout: a clinical review

La gota es una enfermedad articular crónica, habitualmente autolimitada; a través del tiempo con cierta frecuencia se encuentran nódulos llamados tofos y se asocia a litiasis renal. Se analiza el metabolismo del ácido úrico, la incidencia de la enfermedad, el mecanismo de la inflamación. En el cuadro clínico se describe el ataque agudo, la gota crónica tofácea. Se hace énfasis en el tratamiento del ataque agudo, de la gota crónica y de la litiasis renal úrica