Patrón nutricional en pacientes con gota / Nutritional pattern in patients with gout

Introducción: La gota es una enfermedad metabólica caracterizada por cuadros inflamatorios monoarticulares fundamentalmente en miembros inferiores, cuyos factores de riesgo están relacionados con la nutrición: La principal complicación ocurre a nivel renal. Objetivo: Identificar el patrón nutricional de los pacientes con gota atendidos en la Consulta de Nutrición del Hospital Andino de Chimborazo entre enero del 2018 y julio del 2019. Métodos: Investigación básica, descriptiva y transversal; el universo fueron 53 pacientes con diagnóstico de gota. La muestra quedó constituida por 47 pacientes que cumplieron los criterios de inclusión. Se determinó el patrón alimentario teniendo en cuenta el estado nutricional, el perfil lipídico y el nivel de conocimiento sobre nutrición saludable. Resultados: El promedio de edad fue de 58,72 años, con predominio de pacientes blancos (55,32 por ciento) entre 50 y 59 años (44,68 por ciento) y con tiempo de evolución de la enfermedad entre 1 y 5 años (61,70 por ciento). En el 82,98 por ciento de ellos se identificaron alteraciones nutricionales por exceso, mientras que el 51,06 por ciento de ellos tenía un nivel de conocimiento bajo sobre nutrición saludable. Los triglicéridos estuvieron elevados en el 46,81 por ciento de los pacientes, mientras que el 38,30 por ciento presentó aumento del colesterol total. Conclusiones: Entre los pacientes con diagnóstico de gota existió un predominio de patrones nutricionales inadecuados. Los factores principales fueron el bajo nivel de conocimiento sobre nutrición saludable y los trastornos nutricionales por exceso. Los patrones nutricionales inadecuados favorecen la actividad de la xantino oxidasa, que aumenta la producción de ácido úrico y su acumulación sérica y articular(AU)

Introduction: Gout is a metabolic disease characterized by mono-articular inflammatory conditions primarily in the lower limbs; The main complication occurs at the renal level. Objective: The dietary pattern of patients with drops treated at the Andean Hospital of Chimborazo in the period between January 2018 and July 2019. Methods: Basic, descriptive and correlational research, universe to 53 patients with gout diagnosis. The sample consisted of 47 cases that met the inclusion criteria. The eating pattern was determined taking into account nutritional status, lipid profile and level of knowledge about healthy nutrition. Pearson's correlation coefficient was applied to identify relationship between variables. Results: Average age of 58.72 years with a predominance of patients between 50 and 59 years (44.68 percent) and with time of evolution of the disease between 1 and 5 years (61.70 percent). In 82.98 percent of the patients, excess nutritional alterations were identified, while 51.06 percent of them presented a low level of knowledge about healthy nutrition. Triglycerides were elevated in 46.81 percent of the patients, while 38.30 percent had an increase in total cholesterol. Conclusions: There was a predominance of patients with a diagnosis of gout and adequate nutritional patterns. The greatest effects were the low level of knowledge about healthy nutrition and the increased presence of excess nutritional disorders. Inadequate nutritional patterns favor the activity of xanthine oxidase by increasing the production of uric acid and its serum and joint accumulation(AU)

Comportamiento epidemiológico de la hiperuricemia en el Policlínico Universitario Ciro Frías Cabrera, municipio Imías, Guantánamo / Epidemiological behavior of hyperuricemia in the University Polyclinic Ciro Frías Cabrera, municipality of Imías, Guantanamo

Se realizó un estudio descriptivo transversal en el Policlínico Universitario del municipio de Imías "Ciro frías Cabrera", Guantánamo, en el período comprendido de enero a junio de 2017, con el objetivo de caracterizar el comportamiento epidemiológico de la hiperuricemia en la población atendida. Se evaluaron las determinaciones de los valores de referencia de los individuos según sexo y se utilizó el intervalo de la Empresa de Productos Biológicos "Carlos J Finlay". El universo estuvo conformado por 60 pacientes y 48 prestadores (médicos). Predominando el sexo masculino, el grupo etario más significativo fue el de mayor de 30 años, presentándose valores de ácido úrico dentro de los intervalos de referencia en algunos pacientes, sin embargo, estos reflejaban síntomas de gota, relacionada con inadecuada labor educativa y el bajo nivel cognoscitivo e interpretación de los valores de intervalos normados para el diagnóstico de la gota por los prestadores(AU)

A cross-sectional descriptive study was carried out in the Imías "Ciro Frías Cabrera" teaching polyclinic in the period from January to June 2017, with the objective of characterizing the epidemiological behavior of Hyperuricemia in the assisted population. The determinations of the reference values of the individuals according to sex were evaluated and the interval of E.P.B "Carlos J Finlay" was used. The universe consisted of 60 patients and 48 providers (doctors). Predominantly the male sex with 32 people for 53 %, the most significant age group was the one of over 30 years, presenting values of uric acid within the reference intervals in 48 patients, however, these reflected symptoms of gout, related with inadequate educational work and the low level of cognition and interpretation of the values of regulated intervals for the diagnosis of gout by providers(AU)

Tratamento da Gota na Atenção Primária à Saúde / Treatment of Gout in the Primary Health Care / Tratamiento de la Gota en la Atención Primaria de la Salud

Objetivo: O objetivo desta revisão é fornecer informação atualizada e orientações práticas sobre a abordagem da gota na Atenção Primária à Saúde. Métodos: Foram pesquisadas normas de orientação clínica, revisões sistemáticas, meta-análises e estudos originais publicados entre 1 janeiro de 2011 e 31 dezembro de 2016, nas línguas inglesa, portuguesa e espanhola. Resultados: Os fármacos de primeira linha no tratamento da gota aguda são os anti-inflamatórios não esteroides, a colchicina e os corticoides, em monoterapia ou associação. Na gota crônica são usados hipouricemiantes, sendo a primeira linha o alopurinol. O febuxostate e os uricosúricos são alternativas ao alopurinol em casos de intolerância ou ineficácia. A profilaxia das crises de gota agudas está recomendada quando se inicia o tratamento hipouricemiante durante pelo menos 6 meses. Conclusão: A abordagem correta da gota deve fazer parte das competências de um médico especialista em Atenção Primária à Saúde de modo a prestar cuidados adequados à comunidade.

Objective: The objective of this review is to provide updated information and practical guidelines on the approach of gout in Primary Health Care. Methods: We conducted a survey of clinical guidelines, systematic reviews, meta-analyses and original studies published between January 1, 2011 and December 31, 2016 in the English, Portuguese and Spanish languages. Results: First-line drugs in the treatment of acute gout are non-steroidal anti-inflammatory drugs, colchicine and corticosteroids, in monotherapy or combination. In chronic gout, the first-line of hypouricemic therapy is allopurinol. Febuxostat and uricosurics are alternatives to allopurinol in cases of intolerance or ineffectiveness. The prophylaxis of acute attacks is recommended when starting hypouricemic treatment for at least 6 months. Treatment of asymptomatic hyperuricemia is not recommended. Conclusion: The correct approach to gout should be part of the skills of a Primary Care physician in order to provide adequate care to the community.

Objetivo: El objetivo es proporcionar información actualizada y orientación práctica sobre la terapéutica de la gota en la Atención Primaria de Salud. Métodos: Se estudiaron las guías clínicas, revisiones sistemáticas, meta-análisis y estudios originales publicados entre el 1 de enero de 2011 y el 31 de diciembre de 2016, en el inglés, portugués y español. Resultados: Los fármacos de primera línea en el tratamiento de la gota aguda son anti-inflamatorios no-esteroides, la colchicina y los corticosteroides, solos o en combinación. En la gota crónica son utilizados hipouricemiantes, y el alopurinol es lo fármaco de primera línea. Febuxostat y uricosúricos son alternativas al alopurinol en los casos de intolerancia o ineficacia. Se recomienda la profilaxis de las crisis agudas en el tratamiento hipouricemiante durante al menos 6 meses. No se recomienda el tratamiento de la hiperuricemia asintomática. Conclusión: La terapéutica de la gota debe formar parte de las competencias de un médico especialista en Atención Primaria de Salud a fin de proporcionar la atención adecuada a la comunidad.

The Relationship between Homocysteine and Uric Acid Levels in Gouty Patients

No abstract available.

Gota axial / Gout in the spine

A gota axial pode afetar todos os segmentos da coluna vertebral. Ela se manifesta como dor nas costas, dor associada com sintomas neurológicos, e como comprometimento neurológico sem dor em 17,9%, 75,8% e 4,2% dos casos, respectivamente. Essas manifestações foram a primeira apresentação da gota em muitos pacientes. Embora radiografias, bem como tomografia computadorizada e especialmente ressonância magnética, possam ser muito sugestivos, análises histopatológicas, citológicas e pesquisa de cristais são o padrão ouro de diagnóstico. Na maioria dos casos que envolveram manifestações neurológicas, o paciente foi submetido à cirurgia, levando a resultados satisfatórios. Há, no entanto, alguns relatos de recuperação total após o tratamento clínico habitual para gota, o que sugere que esse tratamento pode ser a opção inicial para os indivíduos com histórico de gota e sinais radiológicos de envolvimento axial.

Axial gout can affect all segments of the spine. It is manifested as back pain, as pain associated with neurological symptoms, and as neurological impairment without pain in 17.9%, 75.8% and 4.2% of cases, respectively. These manifestations were the first presentation of gout in many patients. Although x-rays as well as computed tomography and especially magnetic resonance scans can be very suggestive, histopathological, cytological and crystal analyses are the diagnostic gold standard. In most cases involving neurological manifestations, the patient underwent surgery, leading to satisfactory results. There are, however, some reports of full recovery following the usual clinical treatment for gout, suggesting that such treatment may be the initial option for those subjects with a history of gout and radiological findings of axial involvement.

Tofo gotoso nasal: resección y tratamiento reconstructivo de secuelas / Nasal gouty tophus: resection and reconstructive treatment of sequelae

La gota es la artropatía más frecuente causada por microcristales, que afecta principalmente a hombres entre los 30 y 50 años. Su diagnóstico se confirma en presencia de hiperuricemia, tofo gotoso, ataques agudos de artritis y/o artritis crónica. Los tofos son conglomerados de cristales de urato que se localizan por lo general en las articulaciones de las extremidades, y rara vez ocurren a nivel nasal. En la literatura se han publicado tres casos de tofo gotoso nasal en los últimos 50 años. En este artículo se reportan dos casos clínicos de pacientes masculinos de 54 y 60 años con tofo gotoso nasal. Se enfatiza en su presentación clínica, hallazgos radiológicos, resección quirúrgica, secuelas estructurales sobre el dorso nasal, reconstrucción de defectos con injertos autólogos y evolución a largo plazo.

Gout is the most common crystals arthropathy, it mainly affects men between 30 and 50 years old. Diagnosis is confirmed by the presence of hyperuricemia, gouty tophus, acute attacks of arthritis and/or chronic arthritis. Tophi are clusters of urate crystals that area located mainly in the joints of the extremities, they rarely occur in the nose. In the literature have been published three cases of nasal tophi in the last 50 years. We report two cases of male patients 54 and 60 years old with nasal tophi. Emphasis is placed on the clinical findings, surgical resection, structural sequelae on the nasal dorsum, reconstruction with autologous grafts and long-term evolution.

Diagnóstico da monoartrite aguda na emergência / Diagnosis of acute monoarthritis in emergency

JUSTIFICATIVA E OBJETIVOS: A apresentação clínica B de artrite aguda na emergência é frequente e seu diagnóstico, etiológico é desafiador, tendo uma gama de possíveis diagnósticos. A correta avaliação da causa precipitante do sintoma é de extrema importância para orientar o tratamento adequado, minimizando as complicações. O objetivo deste estudo foi auxiliar o médico emergencista, no atendimento de pacientes adultos com quadro clínico de artrite aguda, em articulação nativa. CONTEÚDO: Artigos publicados entre 1970 e 2009, foram selecionados no banco de dados do MedLine através a das palavras-chave: monoartrite e emergência, assim como diretrizes internacionais foram buscadas no link http: sumsearch.uthsca.edu. Adicionalmente, referências destes a artigos, capítulos de livros e artigos históricos foram avaliados CONCLUSÃO: A artrite aguda é uma situação de emergência clínica, associada à fatores precipitantes e etiologias diversas. O correto atendimento, assim como o diagnóstico etiológico, assegura a recuperação e melhoria dos pacientes. Entre as etiologias de artrite aguda, deve-se salientar a importância da artrite infecciosa, devido suas complicações e sequelas, caso não seja instituído tratamento adequado.

Epidemiology and clinical manifestation of GOUT in Imam Khomeini Hospital in Tehran, Islamic Republic of Iran

Gout is an increasingly prevalent condition worldwide, creating a heavy economic burden. Acute gout can be effectively treated with non-steroidal anti-inflammatory drugs and recurrent episodes can be prevented with the uricostatic xanthine oxidase inhibitors. This study was conducted to determine the epidemiology and clinical manifestations of 100 patients with acute or chronic gout in Imam Khomeini Hospital in Tehran, Iran. One-hundred patients with gout who referred to the Rheumatology Department were reviewed. Their demographic data, family and drug history, comorbide diseases, body mass index, symptoms and signs at the time of referral to our clinic and lab data were collected. Among patients, 84 were men and 16 women [mean age=55.8 years and mean Body Mass Index=26.1 kg/m[2]. Thirty three percent of the patients were smokers and 10% drank alcohol. Seventy cases had previous gout attack of whom, 56 were in the first metotarso-phalangeal joint. The mean serum uric acid was 8.5 mg/dl. In our study, the mean age and mean body mass index of the patients were similar to those in others studies. Alcohol consumption was low in our study. Hypertension was found to be a risk factor for gout

Fine needle aspiration of tophi in asymptomatic gout--a case report.

Gout, a chronic hyperuricemic crystal induced arthropathy, may produce soft tissue masses (tophi). Tophi may be found in synovial membranes, periarticular ligaments, tendons, soft tissues as well as internal organs. We present a case in which diagnosis of gout was made by fine needle aspiration of tophus. The patient had a painless nodule over right ankle which was progressively increasing in size. He gave a past history of painful arthropathy, but serum uric acid levels were within normal limits. At this juncture, FNAC of the ankle tophus was performed which revealed aggregated and innumerable dissociated needle-shaped negatively birefringent crystals of monosodium urate (MSU) on polarization microscopy.

FNAC of gouty tophi--a case report.

A 52 yrs old male presented with multiple, painless, firm nodules over extremities, which were mimicking benign neoplastic lesion. Fine needle aspiration was performed from three such nodules which revealed chalky white aspirate. After staining the smears with H&E and Giemsa stains, smears show amorphous pink material, needle shaped crystalline structures, many macrophages and foreign body type giant cells. A diagnosis of gouty tophi was offered which was confirmed by histopathology and serum uric acid level.

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

Paniculitis por gota / Panniculitis for gout

Presentamos el caso de un paciente de 39 años con multiples nodulos subcutaneos en rodillas, codos, cuellos de pie y pequeñas articulaciones de manos de seis años de evolucion asociado con la presencia de paniculitis por cristales de urato monosodico. La presencia de paniculitis en la gota es inusual, ha sido informada pocas veces en la literatura y creemos que debe considerarse a la gota dentro del diagnostico diferencial de ésta

Gota e hiperuricemia / Gout and hyperuricemia

La lesión articular por microcristales de urato monosódico es la artritis mas frecuente en el sexo masculino entre los 40 y 60 años. Su presentación clínica clásica esta precedida por un estado morbido de hiperuricemia que debe ser adecuadamente reconocido y manejado. Una vez la gota se presenta clínicamente el papel del médico consiste no solo en tratar el episodio agudo sino en realizar un enfoque diagnóstico y terapéutico acorde con los parámetros internacionales, buscando un control sintomático rápido y seguro. Esta revisiàn incluye conceptos sobre la etiopatogenia, presentación clínica, criterios de diagnóstico y las diferentes opciones terapéuticas disponibles hoy en dia.

Gota. Aspectos radiologicos / Clinical and radiological aspects of gout

En este artículo realizamos una revisión sobre los aspectos clínicos y radiológicos de la gota, con ilustraciones de los hallazgos radiológicos mas frecuentes que orienten hacia un diagnóstico correcto de la enfermedad. Los casos presentados los hemos analizado durante muchos años en nuestro servicio de reumatología de la Universidad Nacional de Colombia, Hospital San Juan de Dios, Bogotá.