Toward development of a Tophus Impact Questionnaire: a qualitative study exploring the experience of people with tophaceous gout.

BACKGROUND: Although tophi are known to affect physical function, the impact of tophi on the lives of people with gout has not been explored in detail. OBJECTIVES: The aim of this qualitative study was to understand the experience of people living with tophaceous gout, as the first step to developing a patient-reported Tophus Impact Questionnaire. METHODS: Twenty-five people with tophaceous gout (22 men; median age, 66 years; median gout disease duration, 26 years) participated in semistructured interviews that explored their experiences and perceptions of tophi. Interviews were recorded and transcribed. The transcripts were analyzed and coded to identify themes using content analysis. RESULTS: Three major interrelated themes arose from the interviews. The first theme was functional impact affecting body structures and functions (causing pain, restricted joint range of motion and deformity, and complications), and causing activity limitation and participation restriction (affecting day-to-day activities, leisure activities, employment participation, and family participation). The second theme was psychological impact including low self-esteem, embarrassment, resignation, but also optimism. The third theme was the lack of impact in some participants. CONCLUSIONS: Gouty tophi can have an important impact on many aspects of the patient's life. In addition to the impact of tophi on physical function, tophi may also influence social and psychological functioning. Capturing these aspects of the patient experience will be important in the development of a patient-reported outcome measure of tophus burden.

Effect of acute gouty arthritis on sleep patterns: a preclinical study.

BACKGROUND: It has been demonstrated that the interrelation between pain and sleep produces changes in sleep patterns and pain perception. Although some evidences suggest that sleep and pain may interact in a complex way, polysomnographic studies in animals with acute nociception are limited in number. AIMS: This study was carried out in order to evaluate the effect of intra-articular knee injection of uric acid on sleep-wake patterns. METHODS: Surgical electrode implantation was performed in seven anesthetized Wistar rats to carry out 10 h polysomnographic recordings. Acute nociception was induced by the intra-articular administration of 30% uric acid crystals into the knee joint of the right hind limb. Two recordings before and after intra-articular drug administration were obtained. Sleep-wake parameters were classified as (i) wakefulness (W), (ii) slow wave sleep (SWS), and (iii) rapid eye movement (REM) sleep. Frequency and duration from each parameter were evaluated under the two above-mentioned conditions. RESULTS: Intra-articular administration of uric acid induced: (i) an increased duration of wakefulness (p=0.014), (ii) a decrement in the duration (p=0.001) and number of events (p=0.027) in REM sleep, and (iii) a decrement in the total sleep time (p=0.001). SWS did not present statistical differences between groups. CONCLUSIONS: These data suggest that a nociceptive stimulus, induced by the intra-articular administration of uric acid, alters the sleep-wake equilibrium with REM sleep being particularly altered. However, further research concerning pain-sleep interaction is needed.

Feeding-induced tonic pain suppression in the chicken: reversal by naloxone.

Endogenous analgesia induced by changes in motivation has been identified in the chicken in previous studies but either the motivational changes were difficult to interpret or the motivation was unpredictable. Experimental sodium urate (SU) arthritis of the ankle joint resulted in pain-coping behaviour (one-legged standing or sitting) for a 2-h period in non-food-deprived birds without access to food. Complete analgesia or marked hypoalgesia was observed in birds which had been food deprived overnight and given access to food immediately after SU injection. This analgesia seen during feeding behaviour in the food-deprived bird could be completely reversed by intravenous injection of naloxone. These results demonstrate that feeding motivation can totally suppress, in some animals, the severe tonic pain of SU arthritis and that this analgesia may be opioid mediated.

[Pain and pain perception in the elderly from the viewpoint of rheumatology]. / Schmerz und Schmerzerleben im Alter aus Sicht der Rheumatologie.

In rheumatology there is the problem of different terminologies and classification systems; additionally there are only few studies on differential diagnosis and course of diseases in people over 65. The analysis of pain is important for diagnosis; people often have problems in exactly describing their pains. The character of pain changes in the course of disease; therefore a continuous pain analysis is necessary.