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Gouty Arthritis (gouty + arthritis)
Kinds of Gouty Arthritis Selected AbstractsGouty arthritis in Australian AboriginesINTERNAL MEDICINE JOURNAL, Issue 5 2000G. CHIN No abstract is available for this article. [source] High performance liquid chromatography (HPLC) in the investigation of gout in palaeopathologyINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2010D. Swinson Abstract Gout is a disease caused by the abnormal accumulation of uric acid in the body, which can result in sodium urate crystals forming tophi at joints, with associated erosion of bone and cartilage. Only two examples of tophi have been reported from archaeological individuals, and the diagnosis of gout based on dry bone manifestations can be difficult. This paper presents preliminary results of a new technique to aid the diagnosis of gout in palaeopathology, namely high performance liquid chromatography (HPLC). Five archaeological skeletons with suspected gout (diagnosed using visual and radiological analysis) and three controls were analysed. Two of the gouty individuals had a white powder in their erosive lesions. HPLC showed the presence of uric acid in bone in four of the five individuals with evidence of gouty arthritis and was negative for uric acid in bone from the three controls. The white powder was also positive for uric acid. With reliance on the presence of articular erosions, cases of gout will be missed in archaeological human bone. HPLC measurement of uric acid could prove useful in the differential diagnosis of erosive arthropathy in archaeology. It may also be useful in identifying individuals with an increased body pool of uric acid, linked to conditions included in the term ,metabolic syndrome'. As a result, HPLC uric acid measurement also has the potential to provide additional information on health and lifestyle in past communities. Copyright © 2008 John Wiley & Sons, Ltd. [source] Does prolonged systemic glucocorticoid use increase risk of tophus formation among gouty arthritis patients?INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2009Anne-Annette P. RASO Abstract Aim:, To determine the relationship of steroid use with tophus formation and other comorbid conditions among male gout patients. Methods:, Review of medical records of Filipino gout patients under the care of rheumatologists was conducted. Univariate analysis (chi-square, Student's t -test) and multiple logistic regression analysis were performed to establish the risk for tophus formation among glucocorticoid users. Bivariate analysis was separately done to determine the confounding effect of steroid use in the association of comorbidities and tophi formation. Results:, There were 295 Filipino men with a mean age of 56 years and a mean duration of 12 years of gouty arthritis who were included in the study. Multivariate analysis showed a five times higher likelihood (OR 4.81 95% CI 1.92,12.04, P < 0.001) for tophus formation among prolonged steroid users. Confounders identified were disease duration of gout (, 10 years), presence of chronic kidney disease (CKD) and elevated serum creatinine level (SCr). Bivariate analysis of comorbidities showed that steroid use introduced a considerable bias in the relationship of hypertension, elevated SCr, CKD and dyslipidemia. Conclusion:, Patients with equivalent prednisone intake of at least 15 mg/week for , 3 months is associated with tophi formation. In the presence of hypertension, renal impairment, and elevated serum creatinine level, use of steroids confounds the individual risk that each factor carries. [source] Rheumatic disease in the Australian Aborigine of Cape York Peninsula: a 1965 studyINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2004William Alexander DOUGLAS Abstract Aim:, To study the prevalence of rheumatic disorders in two Aboriginal populations on the western coast of Cape York Peninsula. Methods:, Physical and radiological examination of 217 adult Aborigines at Aurukun Aboriginal Mission and 71 Aboriginal adults at Weipa Mission. The study was performed in October 1965. Results:, Mild to moderate degenerative arthritis was not uncommon in the populations examined. However, generalised or nodal osteoarthritis was not seen. One young woman had definite sero-positive rheumatoid arthritis. This woman's appearance suggested some Torres Strait Islander influence. No case of gouty arthritis or classical ankylosing spondylitis was encountered. An incidental finding of retrospective interest was that the calculated body mass index showed that the majority of adults were underweight by Caucasian standards. Conclusions:, These findings are of historic interest given the health impacts of social, cultural and environmental circumstances of Aborigines currently reported. [source] Reversible acute renal failure associated with hypothyroidism: Report of four cases with a brief review of literatureNEPHROLOGY, Issue 2 2003Ahmad MOORAKI SUMMARY: ,,We present four adult cases of acute renal failure associated with hypothyroidism. All patients presented with symptoms suggestive of moderate to severe hypothyroidism, such as cold intolerance, constipation, muscle weakness, and lower extremity oedema. Initial serum creatinine levels ranged between 115 and 203 µmol/L (1.3 and 2.3 mg/dL), with creatinine clearances (CrCl) ranging between 0.58 and 0.97 mL/s (34.5 and 58 mL/min). After 6,12 weeks of treatment with levothyroxin, serum creatinine levels decreased to the range of 80 and 124 µmol/L (0.9 and 1.4 mg/dL) and CrCl increased to 0.74,1.64 mL/s (44,98 mL/min). One patient had proteinuria of 800 mg/day, which decreased to the normal range (<200 mg/day) after levothyroxin treatment. One patient developed acute gouty arthritis before normalization of thyroid-stimulating hormone (TSH), which was successfully managed with prednisone therapy. All of our patients had increased creatine kinase (CK), ranging between 1000 and 2360 U/L (normal range, 22,165 U/L), which normalized after 6 weeks of levothyroxin treatment. [source] Latest news and product developmentsPRESCRIBER, Issue 12 2008Article first published online: 14 JUL 200 Patients want to stop ,Z' drugs more than benzos A study from Lincolnshire has revealed that patients prescribed a ,Z' drug - zaleplon (Sonata), zolpidem or zopiclone - for insomnia are more likely to want to stop treatment than those prescribed a benzodiazepine (Br J Gen Pract 2008;58:417-22). The cross-sectional survey of 705 patients prescribed a hypnotic for insomnia found that more patients taking a Z drug wanted to stop (23 vs 12 per cent prescribed a benzodiazepine) and tried to stop treatment (52 vs 41 per cent). New NICE guidance NICE has published an updated clinical guideline for the management of type 2 diabetes, covering: the control of blood glucose with lifestyle modification, oral hypoglycaemic drugs and insulin; reducing blood pressure and lipids, antithrombotic therapy and estimating cardiovascular risk; and screening and treatment for long-term complications. There is also a new clinical guideline on cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. New technology appraisals include the use of erythropoietin analogues for cancer-associated anaemia, and adalimumab (Humira) and etanercept (Enbrel) for ankylosing spondylitis; infliximab (Remicade) is not recommended. See New from NICE (pages 13-14) for further details. Prescriber consultant editor wins award Professor Tony Avery, professor of primary care at Nottingham University and consultant editor for Prescriber, has won the John Fry Award for his work in promoting the discipline of general practice through research and publishing as a practising GP. The citation acknowledges Professor Avery as ,quite simply one of the best researchers we have had in general practice,' describing his output of original work and research as impressive. The award commemorates the work of the late Dr John Fry, perhaps the most prominent GP of his generation involved in research. Antihypertensive dose ignores adherence Clinicians take no account of poor adherence when they increase the dose of antihypertensive therapy due to apparent lack of effect, US researchers say (Circulation 2008; published online May 27; doi 10.1161/CIRCULATIONAHA.107.724104). Their retrospective analysis included reimbursement records for 38 327 patients with hypertension who presented with elevated BP (140-200/>90mmHg) in one year (mean 1.8 events per patient). After adjusting for potential confounders, they found that antihypertensive medications were added or the dose of medication increased in about one-third of patients regardless of the degree of nonadherence in the previous year. LABAs improve COPD Inhaled long-acting beta2-agonists (LABAs) improve COPD and do not increase the risk of death, a new safety review has concluded (Chest 2008;133:1079-87). The meta-analysis of 27 RCTs in patients with moderate to severe stable COPD found that LABAs reduced exacerbations by 22 per cent, improved lung function, reduced use of rescue medication and improved quality of life. There was no effect on respiratory deaths, though a combination of a LABA with an inhaled steroid reduced the risk by two-thirds compared with LABA monotherapy. Tiotropium (Spiriva) was associated with a 50 per cent lower risk of exacerbations than LABAs. These findings follow the MHRA's review of LABAs in the treatment of asthma, which found no increase in mortality provided they are used with an inhaled steroid (Drug Safety Update 2008;1:9). Naproxen as effective in acute gouty arthritis Naproxen is as effective as prednisolone in the treatment of acute gouty arthritis, say researchers from The Netherlands (Lancet 2008;371:1854-60). Their study in 118 primary care patients showed that five days' treatment with naproxen 500mg twice daily or prednisolone 35mg daily reduced pain scores to a similar extent with a comparable incidence of adverse effects. Copyright © 2008 Wiley Interface Ltd [source] Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: Results of a multicenter, phase II, dose-ranging study,ARTHRITIS & RHEUMATISM, Issue 10 2010Alexander So Objective To assess the efficacy and tolerability of canakinumab, a fully human anti,interleukin-1, monoclonal antibody, for the treatment of acute gouty arthritis. Methods In this 8-week, single-blind, double-dummy, dose-ranging study, patients with acute gouty arthritis whose disease was refractory to or who had contraindications to nonsteroidal antiinflammatory drugs and/or colchicine were randomized to receive a single subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg; n = 143) or an intramuscular dose of triamcinolone acetonide (40 mg; n = 57). Patients assessed pain using a 100-mm visual analog scale. Results Seventy-two hours after treatment, a statistically significant dose response was observed for canakinumab. All canakinumab doses were associated with numerically less pain than triamcinolone acetonide; thus, a dose with equivalent efficacy to triamcinolone acetonide 72 hours after treatment could not be determined. The reduction from baseline in pain intensity with canakinumab 150 mg was greater than with triamcinolone acetonide 24, 48, and 72 hours after treatment (differences of ,11.5 mm [P = 0.04], ,18.2 mm [P = 0.002], and ,19.2 mm [P < 0.001], respectively), and 4, 5, and 7 days after treatment (all P < 0.05). Canakinumab significantly reduced the risk of recurrent flares versus triamcinolone acetonide (P , 0.01 for all doses) (relative risk reduction 94% for canakinumab 150 mg versus triamcinolone acetonide). The overall incidence of adverse events was similar for canakinumab (41%) and triamcinolone acetonide (42%); most were mild or moderate in severity. Conclusion Our findings indicate that canakinumab 150 mg provides rapid and sustained pain relief in patients with acute gouty arthritis, and significantly reduces the risk of recurrent flares compared with triamcinolone acetonide. [source] Clinical Images: Aggressive gouty arthritis with concurrent involvement of the ankle and cervical spineARTHRITIS & RHEUMATISM, Issue 12 2009Yeon-Ah Lee MD No abstract is available for this article. [source] Severe gouty arthritis and mild neurologic symptoms due to F199C, a newly identified variant of the hypoxanthine guanine phosphoribosyltransferaseARTHRITIS & RHEUMATISM, Issue 7 2009Hang-Korng Ea A deficiency in hypoxanthine guanine phosphoribosyltransferase (HPRT) activity leads to overproduction of uric acid. According to the degree of enzymatic deficiency, a large spectrum of neurologic features can also be observed, ranging from mild or no neurologic involvement to complete Lesch-Nyhan disease. Herein, we describe a patient with hyperuricemia, juvenile-onset gouty arthritis, nephrolithiasis, and mild neurologic symptoms, attributed to a newly identified variant of the hprt gene, c.596T>G, resulting in the amino acid change p.F199C. Residual HPRT activity (8%) protected against severe neurologic involvement in this patient. Modeling of the mutated protein was used to predict the mechanisms that led to partial enzymatic activity. Careful neurologic examination is warranted in juvenile and middle-aged patients with gout, in order to detect mild symptoms that may lead to a diagnosis of HPRT deficiency. [source] Rapid induction of peroxisome proliferator,activated receptor , expression in human monocytes by monosodium urate monohydrate crystalsARTHRITIS & RHEUMATISM, Issue 1 2003Tohru Akahoshi Objective Peroxisome proliferator,activated receptor , (PPAR,) is a member of the nuclear hormone receptor superfamily and functions as a key regulator of lipid and glucose metabolism, atherosclerosis, and inflammatory responses. This study was undertaken to evaluate the biologic role of PPAR, in self-limiting episodes of acute gouty arthritis. To do this, we investigated PPAR, expression by monosodium urate monohydrate (MSU) crystal,stimulated monocytes, and we studied the effects of PPAR, ligands on crystal-induced acute inflammation. Methods PPAR, expression by MSU crystal,stimulated human peripheral blood mononuclear cells was determined by reverse transcription,polymerase chain reaction and immunostaining. Expression of CD36 on monocytes was detected by flow cytometric analysis. The effects of PPAR, ligands on in vitro crystal-induced cytokine production and on in vivo cellular infiltration during crystal-induced acute inflammation were also investigated. Results MSU crystals rapidly and selectively induced PPAR, expression by monocytes. Gene expression was detected as early as 2 hours, and maximum expression was observed at 4 hours after stimulation. The induced PPAR, was functional, since a PPAR, ligand was able to up-regulate CD36 expression on monocytes. A natural ligand of PPAR,, 15-deoxy-,12,14 -prostaglandin J2 (15deoxy-PGJ2), significantly reduced the crystal-induced production of cytokines by monocytes. Indomethacin inhibited cytokine production only at high concentrations, and an antidiabetic thiazolidinedione (troglitazone) failed to exert significant effects. Administration of troglitazone and 15deoxy-PGJ2 significantly prevented cellular accumulation in a mouse air-pouch model of MSU crystal,induced acute inflammation. Conclusion Rapid induction of PPAR, expression on monocytes by MSU crystals may contribute, at least in part, to the spontaneous resolution of acute attacks of gout. [source] | ||||||||||