Development and validation of a simple and noninvasive method for salivary uric acid: potential applications for monitoring the salivary uric acid level in healthy volunteers and gout patients

Abstract Serum uric acid (UA) is a traditional biomarker in the clinical diagnosis of gout and hyperuricemia. However, serum treatment and storage are cumbersome, and wounds are susceptible to infection. Therefore, in this study, a simple and noninvasive method was developed to detect the UA in human saliva to monitor the gout. An Inertsil ODS-3 column was used for the analysis under the condition of isocratic elution with the mixed solution phosphate buffer (74 mM, pH=2.2): Methanol=98:2 (v:v) and the UV detection at 284 nm. Using salivary UA data from healthy volunteers (HVs) (n=68) and gout patients (GPs) (n=14), we examined the salivary UA difference in their content. The intra-and inter-day accuracy and precision (RSD %) were less than 2.56%, the limit of detection (LOD) of UA was 5.0 ng/mL, the mean recoveries of the corresponding compounds were 102.48%. Saliva levels of UA in HVs and GPs were 35.26±14.06 µg/mL and 91.96±23.90 µg/mL, respectively. The concentrations of salivary UA in GPs were significantly higher than those in HVs ( p < 0.001). This method was also expected to monitor the hyperuricemia and other metabolic disorders in the future

Chronic tophaceous gout in patients with psoriasis

Abstract: Psoriasis is a chronic inflammatory disease of multifactorial etiology influenced by genetic, immunological, and environmental factors. We report the case of a patient with psoriasis for more than 25 years who developed hyperuricemia and chronic tophaceous gout with unusual appearance. In psoriasis, hyperuricemia may occur by increased epidermal cell turnover, which accelerates purine metabolism and has uric acid as the product of its catabolism. The association of psoriasis with hyperuricemia can trigger the onset of gouty arthritis, and pose a greater risk of developing other inflammatory comorbidities. Therefore, it is important to periodically investigate uric acid levels in order to treat changes triggered by hyperuricemia.

Relevant aspects of imaging in the diagnosis and management of gout / Aspectos relevantes do diagnóstico e seguimento por imagem na gota

ABSTRACT Gout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population aging.In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for monosodium urate crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis. In these situations, imaging methods have a fundamental role, aiding in the diagnostic confirmation or excluding other possible differential diagnosis. Conventional radiographs are still the most commonly used method in gout patients’ evaluation; nevertheless, this is not a sensitive method, since it detect only late alterations. In the last years, there have been several advances in imaging methods for gout patients. Ultrasound has shown a great accuracy in the diagnosis of gout, identifying monosodium urate deposits in the synovial membrane and articular cartilage, in detecting and characterizing tophi and in identifying tophaceous tendinopathy and enthesopathy. Ultrasound has also been able to show crystal deposition in patients with articular pain in the absence of a classical gout crisis. Computed tomography is an excellent method for detecting bone erosions, being useful in spine involvement. Dual-energy CT is a new method able to provide information about the chemical composition of tissues, with high accuracy in the identification of monosodium urate deposits, even in the early stages of the disease and in cases of difficult characterization. Magnetic resonance imaging is useful in the evaluation of deep tissues not accessible by ultrasound. Besides the diagnosis, with the emergence of new drugs that aim to reduce tophaceous burden, imaging methods have become useful tools in monitoring the treatment of patients with gout.

RESUMO A gota é uma artrite caracterizada pela deposição de cristais de monourato sódico na membrana sinovial, na cartilagem articular e nos tecidos periarticulares que leva a um processo inflamatório. Na maioria dos casos o diagnóstico é estabelecido por critérios clínicos e pela análise do líquido sinovial, em busca dos cristais de MSU. Porém, a gota pode se manifestar de maneiras atípicas e dificultar o diagnóstico. Nessas situações, os exames de imagem têm papel fundamental, auxiliam na confirmação diagnóstica ou ainda excluem outros diagnósticos diferenciais. A radiografia convencional ainda é o método mais usado no acompanhamento desses pacientes, porém é um exame pouco sensível, por detectar somente alterações tardias. Nos últimos anos, surgiram avanços nos métodos de imagem em relação à gota. O ultrassom se mostra um exame de grande acurácia no diagnóstico de gota, identifica depósitos de MSU na cartilagem articular e nos tecidos periarticulares e detecta e caracteriza tofos, tendinopatias e entesopatias por tofos. A tomografia computadorizada é um ótimo exame para a detecção de erosões ósseas e avaliação do acometimento na coluna. A tomografia computadorizada de dupla-energia, um método novo, fornece informações sobre a composição química dos tecidos, permite a identificação dos depósitos de MSU com elevada acurácia. A ressonância magnética pode ser útil na avalição dos tecidos profundos, não acessíveis ao ultrassom. Além do diagnóstico, com o surgimento de drogas que visam reduzir a carga tofácea, os exames de imagem se tornam uma ferramenta útil no acompanhamento do tratamento dos pacientes com gota.

Artritis seudoséptica presenta sinovitis por cuerpo extraño en un paciente con gota / Pseudoseptic arthritis with foreign body synovitis in a patient with gout

La monoartritis es un reto diagnóstico para el clínico, ya que es extensa la lista de patologías asociadas. En pacientes con diagnóstico establecido de enfermedad articular inflamatoria, se acepta que la monoartritis corresponde a la exacerbación de la enfermedad de base; sin embargo, ignorar el abordaje sistematizado de las monoartritis puede generar omisiones e implicaciones diagnósticas erróneas. En este reporte se analiza el abordaje de un caso de artritis seudoséptica, simulando un ataque agudo de artritis por urato monosódico recurrente en un paciente con retención de cuerpo extraño intraarticular.

Monoarthritis is a diagnostic challenge for the clinician, as the list of associated conditions is quite long. It is accepted that in patients with a diagnosis of inflammatory joint disease monoarthritis represents exacerbation of the underlying disease. However, ignoring the systematized approach to monoarthritides may lead to omissions and mistaken diagnostic implications. This report describes the approach to a case of pseudoseptic arthritis that mimicked an acute episode of recurrent arthritis due to monosodium urate in a patient with retention of an intraarticular foreign body.

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.

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.

Down's syndrome with coexistent gout in 2 patients: Is the association under reported or is the prevalence actually increasing?

This report describes 2 patients diagnosed with Down's syndrome and who developed acute gouty arthritis. While hyperuricemia in gout is a well-known abnormality, association of gout with Down's syndrome has not been widely discussed. With increasing life expectancy in this syndrome, it is likely that more such cases will occur. For early diagnosis and proper management clinicians must be aware of this association

Gota en un lactante / Gout in an infant

Se presenta un caso anátomo-clínico de Gota en un paciente de 1 mes y medio de edad, cuyo diagnóstico, confirmado por la autopsia, no fue sospechado durante su evolución. Son muy pocos los casos publicados a tan corta edad y puede concluirse que se trata de un caso excepcional de interés pediátrico