Nasal gouty tophus

@#A 48-year-old, non-hypertensive, non diabetic man with uncontrolled gouty arthritis presented with a four-day swollen nasal mass. He was assessed to have a nasal abscess at the emergency room and was admitted for urgent management. Paranasal computed tomography (CT) scans showed a heterogeneously enhancing focus with areas of hypodensities in the nasal apex and dorsum extending into the right ala measuring 1.5 x 2.8 x 3.4 cm. with associated erosion of the cartilaginous part of the anterior nasal septum, soft tissue swelling and skin thickening in the nasal dorsum, nasal tip and right zygomatic region that was suspected to relate to an aggressive etiology. Tissue correlation was therefore recommended, and he underwent endoscopic-guided incision and drainage with biopsy and debridement of the nasal mass. The specimen submitted consisted of red to white, irregular, soft tissue fragments with an aggregate measurement of 1.5 x 1.5 x 0.5 cm. Microsections showed deposits of amorphous white to pink material with surrounding fibrosis and acute and chronic inflammatory cell infiltrates and foreign body giant cells. (Figures 1 and 2) Also seen in the background were fragments of sclerotic bone and bacterial colonies. These findings were consistent with gouty tophus with acute and chronic inflammation and bacterial colonization. The culture and sensitivity test of the nasal discharge showed growth of Enterobacter aerogenes (currently named Klebsiella aerogenes) which was identified by an automated mass spectrometry microbial identification system (VITEK® MS). Work-up also included uric acid levels which were within the reference interval at that time (6.57 mg/dL).

A cross sectional validation study of sonographic findings of the first metatarsophalangeal Joint in gout and asymptomatic hyperuricemia

Objective@#Musculoskeletal ultrasound has gained recognition in early identification of crystal deposits in the joints and soft tissues. This study aims to validate the sonographic features of 1st metatarsophalangeal joints (MTPJs) in gout and asymptomatic hyperuricemia (AH).@*Methods@#Patients with gout (n=20) and AH (n=16) underwent a gray-scale ultrasound assessment of both 1st MTPJs on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 blinded trained sonologists for the presence of double contour sign (DCS), erosions, and tophi.

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.

A case of glycogen storage disease type Ⅰa with gout as the first manifestation / 浙江大学学报·医学版

A 24-year-old male was admitted due to recurrent redness, swelling, fever and pain in the ankle, frequently accompanied by hungry feeling. Dual energy CT scans showed multiple small gouty stones in the posterior edge of the bilateral calcaneus and in the space between the bilateral metatarsophalangeal joints. The laboratory examination results indicated hyperlipidemia, high lactate lipids, and low fasting blood glucose. Histopathology of liver biopsy showed significant glycogen accumulation. The results of gene sequencing revealed the compound heterozygous mutations of the G6PC gene c.248G>A (p.Arg83His) and c.238T>A (p.Phe80Ile) in the proband. The c.248G>A mutation was from mother and the c.238T>A mutation was from father. The diagnosis of glycogen storage disease type Ⅰa was confirmed. After giving a high starch diet and limiting monosaccharide intake, as well as receiving uric acid and blood lipids lowering therapy, the condition of the patient was gradually stabilized. After a one-year follow-up, there were no acute episodes of gout and a significant improvement in hungry feeling in the patient.

Lycopodium as a treatment for Urate Deposition (gout) in birds: case report

A 3-year-old male cockatiel (Nymphicus hollandicus) was diagnosed with joint arthritis due to hyperucemiasyndrome. The bird presented deposition of urate crystals on the synovial membrane with inflammation of joints and tendons (tufts), causing listlessness, anorexia and lameness, with difficulty in keeping perched or moving. Laboratory tests displayed an increase in uric acid and creatinine phosphokinase levels, and leukocytosis despite lymphopenia. Unsucessfully, the animal had been treated with allopathic medicine for 2 months, without a favorable response and still developing stressful reaction to handling.Methodology:High dilution therapy was attempted with 2 globules of Lycopodiumclavatum30 cH /bid and Arnica montana30 cH /bid /oral. The most expressive tufts were removed with daily cleaning of the affected area; a new diet was established and perches were removed, allowing the bird to remain on a flat surface until regression of symptoms. The medication was continued for 30 days. On the second appointment, although the caregiver reported episodes of probable pain, there was an improvement in behavior with normal appetite. Lyc30cH /sid was continued and Arn30cH /bid to qid, depending on pain episodes, for over 30 days. The tutor authorized the case report through a consent form. Results and discussion:Follow-up laboratory tests were performed everythree months for one year, reaching normal levels for uric acid (3.5-11 mg/dL) and CK (30-245mg/dL) on the third measurement. The bird presented no formation of new tufts along the second month of treatment. After 12 months, the animal ingests homeopathic globules spontaneously and presents stable clinical presentation (Lyc30cH / sid / 3 times a week) with no recurrence and without side effects nor stressful behavior. Conclusion: In view of these results, it is considered that homeopathic treatment is an option to be considered in the treatment of joint arthritis from hyperuricemia syndrome in birds.

Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome / 中华烧伤杂志

Objective: To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome. Methods: A retrospective observational study was conducted. From May 2012 to December 2021, the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected, including 8 males and 11 females, aged 28-71 (56±11) years, with 12 cases of infected acute wounds and 7 cases of infected chronic wounds. The lesions were located in the limbs, perianal, and sacrococcygeal regions, with original infection ranging from 9 cm×5 cm to 85 cm×45 cm. After admission, the patients were performed with multidisciplinary assisted diagnosis and treatment, and the wounds were treated with debridement and vacuum sealing drainage, according to the size, severity of infection, suture tension, and bone and tendon tissue exposure of wounds, direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair. The levels of cortisol and adrenocorticotropic hormone (ACTH) of patients at 8:00, 16:00, and 24:00 within 24 h after admission were counted. After admission, the number of operations, wound repair methods, and wound and skin/flap donor site healing of patients were recorded. During follow-up, the wounds were observed for recurrent infection. Results: The cortisol levels of 16 patients at 8:00, 16:00, and 24:00 within 24 h after admission were (130±54), (80±16), and (109±39) nmol/L, respectively, and ACTH levels were (7.2±2.8), (4.1±1.8), and (6.0±3.0) pg/mL, respectively; and the other 3 patients had no such statistical results. After admission, the number of surgical operation for patients was 3.4±0.9. The following methods were used for wound repair, including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases, of which 2 cases underwent stage Ⅱ autologous skin grafting after artificial dermis grafting in stage Ⅰ, and 6 cases had pedicled retrograde island flap+autologous skin grafting. The wound healing was observed, showing that all directly sutured wounds healed well; the wounds in 6 cases of autologous skin and/or artificial dermis grafting healed well, and the wounds in 3 cases also healed well after the secondary skin grafting; the flaps in 4 cases survived well with the wounds in 2 cases with distal perforators flap arteries circumfluence obstacle of posterior leg healed after stage Ⅱ debridement and autologous skin grafting. The healing status of skin/flap donor sites was followed showing that the donor sites of medium-thickness skin grafts in the thigh of 4 cases were well healed after transplanted with autologous split-thickness grafts from scalp; the donor sites of medium-thickness skin grafts in 3 cases did not undergo split-thickness skin grafting, of which 2 cases had poor healing but healed well after secondary skin grafting 2 weeks after surgery; the donor sites of split-thickness skin grafts in the head of 2 patients healed well; and all donor sites of flaps healed well after autologous skin grafting. During follow-up of more than half a year, 3 gout patients were hospitalized again for surgical treatment due to gout stone rupture, 4 patients were hospitalized again for surgical treatment due to infection, and no recurrent infection was found in the rest of patients. Conclusions: The infected wounds in patients with iatrogenic Cushing's syndrome have poor ability to regenerate and are prone to repeated infection. Local wound treatment together with multidisciplinary comprehensive treatment should be performed to control infection and close wounds in a timely manner, so as to maximize the benefits of patients.

Double contour sign in early detection of gout among asymptomatic hyperuricemic Filipino patients: A single center tertiary hospital observational study

Objective@#Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients. @*Methods@#Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign. @*Results@#Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p<0.001). @*Conclusion and Recommendation@#There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis maybe necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.

Clinical profile of Filipino patients with young-onset gout

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

A Philippine Tertiary Hospital cross-sectional and registry feasibility study: Gout clinical case scenario

Background@#Gout is one of the most common arthritides affecting Filipinos; yet, there is a lack of updated local data and Clinical Practice Guidelines. @*Objective@#To describe Clinical Case Scenario (CCS) of Filipino patients with gout in a tertiary referral hospital seen over a year. @*Design@#Cross-sectional study. @*Methods@#Patients’ characteristics, risk factors, disease course, management, and CCS were obtained by a rheumatologist using a questionnaire. Descriptive statistics were used. @*Results@#One hundred eight patients were included with a median age of 58 (range 26–80) years. 106 were male (98%); and, 2 were female (2%) who were menopause and had chronic kidney disease (CKD). Most prevalent CCS were stages 9 (29%), 1 (16%), and 2 (15%). The majority of cases had tophi and belonged to CCS 4-9 (62%). This signifies that most patients had advanced gout. Consistent with international and local data: almost half had hypertension (46%), a third had CKD (36%). Most were ethanol drinkers (65%) and smokers (57%). Unexpectedly, not many were obese (10%) or had metabolic syndrome (2%). The initial joint involved was the ankle (52%) rather than the first metatarsophalangeal joint (40%). Almost half of the patients presented with two or more joint involvement (46%) than monoarthritis (54%). Patients with acute flare were most commonly prescribed NSAIDs (77%), followed by colchicine (62%). Most were prescribed allopurinol (44%) compared with febuxostat (37%) for urate-lowering therapy. Only 16% received patient education. Medication compliance was 65%, but follow-up compliance was less than 18%. Comparing the Filipino clinical profile to historical data suggests an increased incidence of gout in the young and an increase in comorbidity prevalence. @*Conclusion@#This study reports a cohort of Filipino gout patients. Comorbidities are similar to world figures but differ in the low incidence of obesity and metabolic syndrome. It also differs from literature in having the ankle as the most common initial joint presentation. Management and compliance were also described. As a pilot study for a registry, this study can be implemented at different institutions to broaden and monitor the ever-changing Filipino gout profile. @*Recommendation@#A larger sample size and a more extended observation period are recommended to estimate gout CCS prevalence, flare risk factors, and treatment response more accurately. Other outcomes that can be measured are mortality rates and etiologies for each CCS.

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

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)

Alternativas de control biorracionales sobre Phytophthora infestans, fitopatógeno causante de la gota en papa / Biorational control alternatives on Phytophthora infestans, phytopathogen causing gout in potatoes

Resumen La gota de la papa o tizón tardío es una de las enfermedades más agresivas que atacan los cultivos de papa y en poco tiempo los destruye, ocasionando enormes pérdidas económicas, es producida por el fitopatógeno Phytophthora infestans, oomyceto que ha tomado gran importancia debido a sus efectos devastadores y las dificultades para lograr su erradicación. Los fungicidas de naturaleza química representan un problema debido al uso inadecuado, lo que hace muy difícil eliminar la enfermedad por la aparición de nuevas especies resistentes. Existen nuevas alternativas para su control, basadas en el uso de sustancias de naturaleza vegetal, y la aplicación de nuevas herramientas capaces de realizar edición de genes, reprogramar o eliminar secuencias de ADN/ARN, favoreciendo así, la obtención de cultivos libres de sustancias tóxicas. En esta revisión, se presentan los métodos existentes de biocontrol: como aceites esenciales, metabolitos microbianos, herramientas moleculares y el uso de sustancias biodegradables que favorecen el manejo y prevención de plagas, que ayudan a mitigar la problemática ambiental generada por el uso de fungicidas de naturaleza química.

Abstract The drop of the potato or late blight is one of the most aggressive diseases that attack the potato crops and in a short time destroys them, causing great economic losses, it is produced by the phytopathogen Phytophthora infestans, oomyceto that has taken great importance due to its devastating effects and difficulties in achieving its eradication. Fungicides of a chemical nature represent a problem due to the affected use, which makes it very difficult to eliminate the disease due to the appearance of new resistant species. There are new alternatives for its control, based on the use of substances of the plant nature, and the application of new specific tools to perform gene editing, reprogram or eliminate DNA / RNA sequences, thus favoring the obtaining of cultures free of toxic substances . In this review, specific biocontrol methods are presented, such as essential oils, microbial metabolites, molecular tools and the use of biodegradable substances that favor the management and prevention of pests, which help mitigate the environmental problems generated by the use of fungicides from chemical nature.

Estudio de utilización de fármacos antigotosos en población colombiana, 2016 / Patterns of anti-gout drug use in a Colombian population: 2016

RESUMEN Objetivo: Identificar las características clínicas de los pacientes con gota y la forma de utilización de los medicamentos antigotosos en Colombia. Métodos: Estudio de corte transversal en el que se analizaron 310 historias clínicas de pacientes atendidos en el último trimestre del 2016 y que recibieron un medicamento antigotoso. Se identificaron variables sociodemográficas, clínicas, farmacológicas, comorbilidades y paraclínicas. Para cada medicamento antigotoso se determinó si el uso fue según las recomendaciones aprobadas por la Federal Drug Administration (FDA). Se realizaron análisis descriptivos, bivariados y multivariados. Resultados: Se evaluaron pacientes de 14 diferentes ciudades de Colombia, con un predominio masculino del 70,3% (n = 218) y una mediana de edad de 64 arios (RIC: 26-94 arios). El antigotoso más frecuentemente utilizado fue alopurinol (n = 255; 82,3%), seguido de colchicina (n = 54; 17,4%). Los diagnósticos hallados como indicación fueron: hiperuricemia (n = 181; 58,4%), gota (n = 34; 11%), artritis gotosa (n = 28; 9%). El 74,5% (n = 231) de las prescripciones tenía un uso aprobado según la FDA, especialmente alopurinol en el manejo de gota e hiperuricemias, mientras que colchicina se encontró siendo utilizada en indicaciones no aprobadas (n = 44; 81,4%). Las comorbilidades más frecuentes fueron hipertensión (68,4%) y dislipidemia (55,8%). Conclusiones: Los pacientes con gota en tratamiento farmacológico tienen una elevada frecuencia de comorbilidades cardiovasculares, y están siendo tratados con alopurinol para la prevención a largo plazo, mientras que una menor proporción recibe colchicina que comúnmente es utilizada para indicaciones no aprobadas por las agencias reguladoras.

ABSTRACT Objective: To identify the clinical characteristics of patients with gout, and the prescription patterns of anti-gout medications in Colombia. Methods: Cross-sectional study, that analysed the data from 310 medical records of patients treated in the last quarter of 2016, and who received an anti-gout medication. Sociodemographic, clinical, pharmacological, comorbidities, and paraclinical variables were identified. For each anti-gout drug used, it was determined whether the use was in accordance with Federal Drug Administration (FDA) approved recommendations. Descriptive, bivariate and multivariate analyses were performed. Results: Patients from 14 different cities in Colombia were evaluated, with a male predominance of 70.3% (n = 218) and a median age of 64 years (RIC: 26-94 years). The most frequently used anti-gout medication was allopurinol (n = 255; 82.3%), followed by colchicine (n = 54; 17.4%). The main diagnoses found as an indication were: hyperuricaemia (n=181, 58.4%), gout (n = 34; 11.0%), and gouty arthritis (n = 28; 9.0%). Almost three-quarters (74.5%; n = 231) of the prescriptions had an approved use according to the FDA, especially allopurinol in the management of gout and hyperuricaemia, while colchicine was found to be used in unapproved indications (n = 44, 81.4%). The most frequent comorbidities were hypertension (68.4%) and dyslipidaemia (55.8%). Conclusions: Patients with gout who are under pharmacological treatment have a high frequency of cardiovascular comorbidities. They were being treated with allopurinol for long-term prevention, while a smaller proportion received colchicine, which is often used for indications not approved by regulatory agencies.

A case report of colchicine-induced myopathy in a patient with chronic kidney disease / 北京大学学报(医学版)

Colchicine plays an important role in the treatment of gout and some other diseases. Besides gastrointestinal symptoms, myopathy has been reported as a rare side effect of colchicine in some patients. We report a case of myopathy in a patient with chronic kidney disease caused by high-dose colchicine, and then review literature on colchicine-induced myopathy, so as to provide some experience for the clinical diagnosis, treatment and medication safety. A 51-year-old male patient with 10 years of gout and 5 years of chronic kidney disease history and irregular treatment was admitted to the hospital with complaint of recurrent left wrist arthralgia and emerging lower extremities myalgia after intake of 40-50 mg colchicine in total within 20 days. Laboratory examinations showed significantly increased creatine kinase (CK) and then colchicine-induced myopathy was diagnosed preliminarily. After withdrawl of colchicine and implementation of hydration, alkalization and intramuscular injection of compound betamethasone, the symptoms of arthralgia and myalgia were relieved within 3 days and CK decreased to normal range gradually. According to literature reports, colchicine related myopathy was mostly characterized by proximal myasthenia and myalgia, accompanied by elevated CK level, which usually occurred days to weeks after initial administration of colchicine at the usual dosage in patients with renal impairment or a change in the underlying disease state in those receiving long-term therapy, and the features might remit within three to four weeks after the drug was discontinued. Electromyography of proximal muscles showed myopathy marked by abnormal spontaneous activity and muscle pathology waa marked by accumulation of lysosomes and autophagic vacuoles. Chronic kidney disease, liver cirrhosis, higher colchicine dose and concomitant cytochrome P450 3A4 (CYP3A4) inhibitors were associated with increased risk of myo-pathy. Based on the similar efficacy and lower adverse reaction rate compared with larger dosage, small dose of colchicine was recommended by many important current guidelines and recommendations in the treatment of gout. In consideration of potential risks, colchicine should be used with caution in patients with kidney or liver impairment, and in those taking CYP3A4 or P-glycoprotein inhibitors. For those patients, the drug dose should be adjusted and the latent adverse reactions should be monitored carefully.

Clinical characteristics of crystal deposits in joints and tendons in patients with gout / 北京大学学报(医学版)

OBJECTIVE@#To explore the abnormal manifestations and clinical features of patients with gout according to the location of crystal deposits: in articulars or in tendons.@*METHODS@#A total of 105 patients with gout who were continuously treated in the Department of Rheumatology and Immunology of Peking University People's Hospital from June 2019 to December 2019 were selected and their knees, ankles, toes and painful joints and tendons were examined by high-frequency ultrasound. Then we grouped them according to the presence or absence of sodium urate crystals and the location of the crystals, collected their clinical data, and analyzed the clinical characteristics.@*RESULTS@#Among the 105 patients, 25 patients had no crystal deposits in the joints or tendons (as the non-crystal group), 43 patients had intra-articular crystals (as the joint group), and 37 patients had intra-tendon crystals with or without intra-articular crystals (as the tendon group). Among them, the most involved part of sodium urate crystals deposited in the joints was the metatarsophalangeal joint (29 cases, 67.4%), followed by knee joints (10 cases, 23.2%), ankle joints (9 cases, 20.9%). The most involved part of sodium urate crystals deposited in the tendon was the quadriceps tendon (16 cases, 43.2%), followed by the Achilles tendon (13 cases, 35.1%), the patellar tendon (12 cases, 32.4%), and the three heads of brachii tendons (5 cases, 13.5%). The three groups were compared using multi-sample analysis of variance/multi-sample rank sum test. Age, age of first increase in uric acid (UA), serum glucose (Glu) level and C reactive protein (CRP) were all significantly different. After multiple comparisons, compared with the non-crystal group, age, the age of first increase in uric acid, and CRP were significantly higher in the tendon group. There was no significant difference between the non-crystal group and the joint group. There was no significant difference between the tendon group and the joint group.@*CONCLUSION@#In patients with gout, it is common for ultrasound to find crystals deposited in joints or tendons. The most commonly affected parts include the metatarsophalangeal joint, knee joint, ankle joint, quadriceps tendon, Achilles tendon, patellar tendon, and triceps tendon. There were significant differences among the three groups in age, age of first increase in uric acid, CRP and blood glucose, and the proportion of urinary calculi in patients with crystal deposits was significantly higher than those without crystal deposits.

Cervical Myelopathy Secondary to Gout: Case Report / Mielopatia cervical secundária a gota: Relato de caso

Abstract Gout is a crystalline arthropathy frequent in the population, but gouty spondyloarthropathy, also called axial gout, is uncommon. The current case report presents a rare case of cervical myelopathy secondary to axial gout. A 50-year-old female patient, without previous pathologies, presented with loss of strength, altered sensitivity, and pyramidal release for 2 years. The computed tomography showed a lytic image in the spinous process of C7, and signs of myelopathy with myelomalacia on magnetic resonance imaging of the cervical spine. After the surgical procedure and biopsy of the material, the diagnosis was gout, and treatment for the pathology was started, with complete improvement of the condition. The diagnosis of axial gout should be included in the spectrum of the differential diagnosis of diseases that affect the spine. Although gouty spondyloarthritis (or spondylitis) is uncommon, there is an underestimated occurrence due to the lack of investigation of the cases. The early diagnosis and treatment of the pathology can prevent patients from presenting complications of the disease, as reported in the present study.

Resumo A gota é uma artropatia cristalina frequente na população; entretanto, a espondiloartropatia gotosa, também chamada de gota axial, é incomum. O presente relato de caso apresenta um caso raro de mielopatia cervical secundária a gota axial. Uma paciente de 50 anos de idade, sem patologias prévias, apresentou quadro de perda de força, alteração de sensibilidade e liberação piramidal há 2 anos. A tomografia computadorizada evidenciou imagem lítica no processo espinhoso de C7, e sinais de mielopatia com mielomalácia foram observados na ressonância magnética da coluna cervical. Após o procedimento cirúrgico e biópsia do material, o diagnóstico foi de gota, e o tratamento para a patologia foi iniciado, com melhora completa do quadro. O diagnóstico de gota axial deve ser incluído no espectro do diagnóstico diferencial das doenças que acometem a coluna vertebral. Apesar de a espondiloartrite gotosa ser incomum, há uma ocorrência subestimada devido a não investigação dos casos. O diagnóstico precoce e tratamento da patologia pode evitar que pacientes apresentem complicações da doença, como a relatada no presente estudo.

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)

Nephrolithiasis in gout: prevalence and characteristics of Brazilian patients

Abstract Background: The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. Methods: One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in São Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. Results: One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 ± 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p < 0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. Conclusions: The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.(AU)

Correlations of echocardiographic parameters in Gout patients: a retrospective analysis / 南方医科大学学报

OBJECTIVE@#To explore the correlations of echocardiographic parameters in patients with gout.@*METHODS@#The hospitalization data and medical records of patients with gout between January, 2012 and June, 2019 were retrieved from the database of Anhui Provincial Hospital of Traditional Chinese Medicine, and the echocardiographic parameters and clinical laboratory test results of the inflammatory, immunological and metabolic indicators were analyzed. SPSS 22.0, SPSS Clementine 11.1 Aprior and other statistical software were used to determine the association rules and carry out correlation analysis, heat map analysis and multi-factor logistic regression analysis of the indicators.@*RESULTS@#Heat map analysis showed that the expressions of EF and SV were the most significant, followed by AODd, LADs, LVDd and FS. Cluster analysis showed that AODd, EF, FS, LADs, LVDd, and SV were all in cluster 1, and IVSTd, LVPWTd, MPAD, Pmax, and RVDd were in cluster 2. Correlation analysis showed that in the 383 patients, EF was negatively correlated with LVDd ( < 0.05) and positively correlated with FS and SV ( < 0.05); AODd was positively correlated with IVSTd, LADs, LVDd, LVPWTd, RVDd, SV, and ESR ( < 0.05); FS was positively correlated with EF and SV ( < 0.05) and negatively correlated with LVDd ( < 0.05);IVSTd was positively correlated with AODd, LADs, LVPWTd, and complement C4 ( < 0.05); LADs were positively correlated with AODd, IVSTd, MPAD, RVDd, and SV ( < 0.05); LVDd was positively correlated with AODd, IVSTd ( < 0.05), and negatively correlated with LVDd and complement C3 ( < 0.05); MPAD and LADs, HDLC and TC were positively correlated ( < 0.05)and negatively correlated with Pmax ( < 0.05); Pmax was positively correlated with LVDd, RVDd and SV ( < 0.05)and negatively correlated with FS and MPAD ( < 0.05); RVDd was positively correlated with AODd, LADs, LVDd, Pmax, SV ( < 0.05); SV was positively correlated with AODd, EF, LADs, LVDd, Pmax, and RVDd ( < 0.05); complement C3 was positively correlated with complement C4 and CRP ( < 0.05), and negatively correlated with LVPWTd ( < 0.05); complement C4 was positively correlated with IVSTd, complement C3, CRP, and ESR ( < 0.05); CRP was positively correlated with complement C3, complement C4, IgA, IgG ( < 0.05), and negatively correlated with TC, HDLC, and TG ( < 0.05); TG was positively correlated with HDLC, IgM, and TC ( < 0.05), and negatively correlated with CRP ( < 0.05); HDLC was positively correlated with MPAD, HDLC and TC ( < 0.05) and negatively correlated with CRP ( < 0.05); IgA was positively correlated with CRP, IgG and IgM ( < 0.05); IgG was positively correlated with CRP, IgA and IgM ( < 0.05); IgM is positively correlated with TG, IgA, IgG, UA ( < 0.05) and negatively correlated with CRP ( < 0.05); UA was positively correlated with IgM ( < 0.05); ESR was positively correlated with AODd and complement C4 ( < 0.05); HCY was negatively correlated with RVDd ( < 0.05); TC was positively correlated with MPAD and TG ( < 0.05), and negatively correlated with CRP ( < 0.05). The increase of Pmax was significantly associated with the increase of LDL-C, UA, complement C4, TG, HCY, HDL-C, IgG, ESR, CRP, and complement C3; the increase of SV was associated with the elevations of UA, LDL-C, complement C4, HDL-C, CRP, IgG, HCY, TC, ESR, TG, and complement C3. Multivariate logistic regression analysis indicated that FS was positively correlated with LDL-C ( < 0.05), Pmax was negatively correlated with IgM ( < 0.05), and SV was negatively correlated with ESR ( < 0.05).@*CONCLUSIONS@#The changes of echocardiographic parameters in patients with gout are correlated with the increase in inflammation, immunity, and metabolic indexes. Patients with a history of smoking and drinking do not show obvious changes in cardiac function. The changes in metabolic indexes are risk factors for changes in echocardiographic parameters.