A case of gout secondary to primary myelofibrosis / 北京大学学报(医学版)

A 52-year-old man was referred to our department with a 2-year history of polyarthritis. He was diagnosed as gout due to acute arthritis of bilateral feet dorsum 2 years ago,but he didn't receive any standard treatment. 1 year ago,there were more and more joints evolved during the gout attack, and many subcutaneous nodules occurred. When he presented to our clinic 1 month ago,the urate acid level was as high as 715 μmol/L. Moreover, we could find bone erosion in the X rays of his hand and foot,as well as synovitis,double contour sign and tophus on the ultrasound examination. The diagnosis of gout was clearly and definitely. However, he had leukocytosis and thrombocytosis for 4 years in the past history, and the urate acid level was only 400 μmol/L at that time. He also had well-controlled hypertension. The family history was unremarkable. Furthermore, we found megalosplenia on his physical examination. The bone marrow examination showed myelofibrosis and JAK2 V617F gene was positive. He was diagnosed as primary myelofibrosis and treated with interferon-α, together with urate acid-lowing therapy (febuxostat 60 mg once daily). Following-up for 1 year,the dosage of febuxostat decreased to 40 mg once daily, and the patient didn't have gout attack again, some of the tophus diminished, and the urate acid level ranged from 400 to 500 μmol/L. Gout is a common disease in clinical practice,usually combined with metabolic syndrome,chronic renal failure and specific drugs using (diuretic and calcineurin inhibitors). However,it is relatively rare to see gout associated with myeloproliferative diseases, including polycythemia vera, primary thrombocythemia, primary myelofibrosis and chronic myelocytic leukemia. In these diseases, the turnover of nucleic acids is greatly augmented, and an excess of purine metabolites, including uric acid, is released. In the natural course of gout, the appearance of tophus from the first onset of arthritis usually takes several years. This patient only had one traditional risk factor, but his urate acid level was remarkably high and he developed tophus in a short term. After treatment of primary myelofibrosis, the symptom of gout partially alleviated. Careful physical examination and medical history taking lead to the diagnosis of secondary gout, which should be reminded in the daily practice.

Clinical manifestations of patients with hyperuricemia.

OBJECTIVE: To study the clinical manifestations of patients with hyperuricemia in King Chulalongkorn Memorial Hospital. METHOD: A cross sectional study of 188 hyperuricemic patients was done at King Chulalongkorn Memorial Hospital. History, physical examination, and blood samples were drawn to assess complete blood count (CBC), blood urea nitrogen (BUN), creatinine (Cr), liver function test (LFT), and serum uric acid in all patients. RESULTS: Most of the patients (92%) were male, more than 50 years old (69%), the mean age of the patients was 56.7 +/- 12.1 years old. All of the female patients were more than 50 years old. Symptomatic hyperuricemia was found in 93%, the mean duration of symptoms was 63.2 +/- 66.3 months. The mean of the serum uric acid level was 10.0 +/- 2.9 mg/dl. Associated diseases were found in 46% of the patients, and 30% of these patients had more than one disease. Hypertension was the most common followed infrequency by dyslipidemia, diabetes mellitus, ischemic heart disease, and chronic obstructive pulmonary disease consecutively. Renal impairment was detected in about one-third of the patients. CONCLUSION: This study shows that hyperuricemia is common in elderly, male patients. Associated diseases and renal impairment can befoundfrequently, and the patients should be monitored.

Manifestaçöes reumáticas em pacientes submetidos a transplante renal / Rheumatic manifestations in patients submitted to renal transplantation

O estudo retrospectivo de 273 pacientes submetidos a transplante renal, no período compreendido entre julho de 1973 e novembro de 1989, revelou apenas 12 casos com manifestaçöes osteo-articulares, dada a reduzida prevalência de osteonecrose, justificada pela utilizaçäo de baixas doses de corticosteróides. Levando-se em conta que dois pacientes apresentaram mais de uma manifestaçäo, tem-se: quatro casos de artrite infecciosa; cinco com artralgias pós-transplante; três osteonecroses; uma artrite otosa e uma epifisiólise da cabeça femoral