RESUMO
Objectives@#Recent studies show that patients with young-onset gout present with visible tophi or nephrolithiasis on diagnosis. In the Philippines, where gout is prevalent, there is no published work on this subset of patients. This study presents the clinical characteristics of a cohort of Filipino patients with gout whose symptoms started at 30 years of age or younger. @*Methods@#The case records of all patients who fulfilled the 1977 American College of Rheumatology (ACR) criteria for gout seen in four adult rheumatology services were reviewed. We selected those whose age of onset of gout was at 30 years or younger. The demographic characteristics, medical history, laboratory parameters, and presenting manifestations were described. @*Results@#Six hundred sixty-nine records of patients with gout were reviewed; 101 (15%) fulfilled the young-onset gout criteria. The mean age of onset was 25±4.40 years (range 14-30), and the mean disease duration before diagnosis was 12.64±11.91 years. All of the patients were male and most were married; 76% were alcoholic beverage drinkers and 38% were smokers. A family history of gout was noted in 47%. Most patients (66%) were already on nonsteroidal anti-inflammatory drugs (NSAIDs), 24% on colchicine, and 14% on urate-lowering therapy before consult at the rheumatology clinic. By history, at onset, the most common pattern of joint involvement was monoarthritis (95%), affecting the ankles (60%), knees (52%), and 1st metatarsophalangeal (MTP) joint (51%). However, on the first rheumatology clinic visit, 34% of arthritis was polyarticular, more than 68% had more than three arthritis attacks per year, and there were tophi in 35%. The mean duration before visible tophi formation was 2.81±6.75 years. Around 21% had nephrolithiasis or a history thereof. The mean serum uric acid (SUA) was 9.18 mg/dL and the mean serum creatinine was 1.5 mg/dL. Thirty-seven percent had estimated glomerular filtration rate (GFR) <60 mL/min. @*Conclusion@#Young-onset gout was present in 15% of our patients and gout was familial in 47%. There was a delay in diagnosis of as long as ten years in most of the patients. On presentation at the rheumatology clinic, more than 34% had polyarticular arthritis, 35% had tophi, and 37% had low estimated GFR. This emphasizes the importance of awareness and prompt diagnosis to ensure correct treatment and prevention of complications
Assuntos
GotaRESUMO
Introduction@#Rheumatoid arthritis (RA) is a chronic autoimmune disease that is severely debilitating with a prevalence in the Philippines of 0.17-0.4%. This study aims to determine rate of methotrexate (MTX) toxicity, identify risk factors and comorbid conditions predisposing to toxicity and describe management of MTX toxicity.@*Methods@#Rheumatoid arthritis (RA) cases from the Rheumatoid Arthritis Database and Registry (RADAR) diagnosed by the 1987 ACR criteria receiving MTX monotherapy or combination disease modifying anti-rheumatic drugs (DMARDs), with at least one dose of treatment, were included. Patients were grouped into those with and without adverse events (AE). Disease activity was measured using DAS 28-ESR. Baseline characteristics, duration of use, dose, concomitant drugs and all toxicities were listed. Management of AEs were described. Independent t-test and Mann-Whitney U test were used for numerical data and Chi-square and Fisher’s exact test for continuous data.@*Results@#One hundred ninety four patients are included, with 95% females, age 35-64 years, disease duration of 0.2-10 years. Eighty three percent are on methotrexate monotherapy. Fifty cases (25.77%) all with dose of 8.75±2.5 had AEs: hepatotoxicity (52%), gastrointestinal (24%), hematologic (14%), dermatologic (8%), pulmonary (6%). Risk factors directly correlated with toxicity were older age (p=0.024), disease duration (p=0.024 ), dose (p<0.000), duration of use (p≤0.001), anemia (p=0.038) and osteoarthritis (p=0.011).Management included dose reduction (52%), dose retention with close monitoring (26%), addition of (24%) or shift to (22%) other DMARDS. Folate dose was increased in all cases.@*Conclusion@#Methotrexate (MTX) toxicity rate of RA patients from the RADAR is similar to those in literature. While dose reduction is the main management strategy, some patients’ doses were maintained while others were shifted to other DMARDS.