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Gouty Arthritis
Arthritides Gouty
Anthonie van Leeuwenhoek (1632-1723). Natuurkundige te Delft
Presentation
- Rarely, gouty arthritis may present with effusion containing thick, milky white fluid. We report a case of gouty arthritis, describing cytologic features of the urate milk.[ncbi.nlm.nih.gov]
- Their presenting hyperuricemia (13.8 and 11 mg/dL, respectively) was out of proportion to the degree of renal insufficiency.[ncbi.nlm.nih.gov]
- In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares. 2013 Chinese Orthopaedic Association[ncbi.nlm.nih.gov]
- A 34-year-old male presented with right knee instability without any trauma. He had been diagnosed with right knee gouty arthritis 2 years prior.[ncbi.nlm.nih.gov]
- Five cases of early-onset gouty arthritis are presented, with roentgenographic abnormalities evident in the first two decades of life.[ncbi.nlm.nih.gov]
Entire Body System
Family History of Gout
- Neither patient had a family history of gout or inherited renal disease.[ncbi.nlm.nih.gov]
- The correct diagnosis was reached by the combination of accurate history taking (family history of gout, alcoholism, previous diuretic therapy and renal stones), guiding clinical features (subcutaneous tophaceous deposits) and specific radiological (assymetrical[ncbi.nlm.nih.gov]
- history of gout, alcohol use, obesity, thiazide administration, lead Aspirate: grossly white gray and granular; strongly negative birefringent needle shaped crystals under polarized light; foreign body giant cells Clinical images Images hosted on other[pathologyoutlines.com]
- history of gout can be obtained in less than half patients' male / female ratio ranging from 7:1 to 9:1 females with gout tend to be postmenopausal; pathophysiology predisposing conditions: common chronic diseases assoc w/ gout include alcoholism, obesity[wheelessonline.com]
- You are more likely to get gout if you: Have a family history of gout. Have had an organ transplant. Are a man. Are an adult. Are overweight. Drink alcohol. Eat a lot of foods rich in purines. Have been exposed to lead.[niams.nih.gov]
Chills
- Reactions can include fever, heart rate increase and chills. The severe joint pain can occur sporadically and last for days. Yet, in some cases, the attacks can last for months.[drlox.com]
- Then follows chills and shiver and a little fever. The pain which at first moderate becomes more intense. With its intensity the chills and shivers increase.[hopkinsarthritis.org]
- Other joints involved (in decreasing order of frequency) include insteps, knees, wrists, fingers, and olecranon bursae. 12 Systemic symptoms and signs of fatigue, fever, and chills may accompany the acute arthritis.[ajmc.com]
- Then follows chills and shivers, and a little fever...[bbc.co.uk]
Increased Energy
- Avoiding Excessive Energy Demands Any activities that increase energy demands also increase metabolism or purines that produce uric acid. Avoiding stress and staying healthy are important for preventing attacks.[web.archive.org]
Gastrointestinal
Gagging
- Moreover, histological analysis of the joints and SM-serum substantially interfered with the MSU-induced expression of glycosaminoglycans (GAG), up-regulated the content of proteoglycan.[ncbi.nlm.nih.gov]
Skin
Gouty Tophus
- The case presented here indicates the possibility of pathologic rupture of the ACL associated with gouty tophus infiltration of that ligament. Level of evidence IV.[ncbi.nlm.nih.gov]
- Rao et al. [ 3 ] reported a case of gouty tophus with normal serum uric acid level. Measurement of serum uric acid is of limited help in the diagnosis of chronic tophaceous gout.[omicsonline.org]
- This review discusses imaging modalities and highlights ultrasongraphic evidence suggesting a significant relationship between the presence of the gouty tophus and bone erosions as well as the frequent presence of persistent low-grade inflammation in[ard.bmj.com]
- Gouty tophus presenting at a soft tissue mass diagnosed by fine-needle aspiration: a case report. Diagn Cytopathol. 1996 ; 15: 246 – 9. Google Scholar Crossref Medline ISI 4. Mackford, BJ, Kincaid, RJ, Mackay, I.[doi.org]
Musculoskeletal
Arthritis
- […] and 29 with gouty arthritis.[ncbi.nlm.nih.gov]
- Cases were defined as patients with gouty arthritis. Factors that are possibly associated with gouty arthritis and/or heart failure were evaluated.[ncbi.nlm.nih.gov]
- Out of 93 patients with gouty arthritis, 36 (38.7 %) showed MEFV gene mutations carriage, whereas 20.6 % in healthy control group.[ncbi.nlm.nih.gov]
- OBJECTIVES: To study the serum Procalcitonin (PCT) level in inflammatory arthritis including gouty arthritis (GA), Rheumatoid arthritis (RA), and ankylosing spondylitis (AS) without any evidence of infection were evaluated the possible discriminative[ncbi.nlm.nih.gov]
- To analyze the factors which differentiate chronic tophaceous arthritis from rheumatoid arthritis. We describe two cases of chronic gouty arthritis masquerading as rheumatoid arthritis.[ncbi.nlm.nih.gov]
Joint Swelling
- Joint swelling, synovial cytokine production and histopathology were determined after 4 h.[ncbi.nlm.nih.gov]
- These are the presence of a clear history of at least two attacks of painful joint swelling with complete resolution within two weeks, a clear history or observation of podagra, the presence of a tophus, and a rapid response to colchicine within 48 hours[doi.org]
Joint Effusion
- MRI revealed capsular thickening in 19 patients, bone marrow edema (BME) in 15, soft tissue edema (STE) in 20, joint effusion in 21, bone erosions in 17, cartilaginous erosions in 4, and tenosynovitis in 9 cases.[ncbi.nlm.nih.gov]
- The early radiological signs of gout are joint effusion and periarticular edema, caused by the deposition of the nonopaque crystals within the synovial and cartilaginous tissues. 5,6,7 Radiographic examination eventually reveals a classic ‘punched-out[appliedradiology.com]
- It often presents with painful joint effusion and commonly is diagnosed either by clinical examination, elevated serum uric acid level or cytological examination of an effusion.[omicsonline.org]
- In the study, it was determined that US facilitated differentiation of the synovial proliferation, joint effusion, popliteal cysts, patellar-quadriceps tendonitis, and cartilage morphology with high concordance rates compared with MRI.[thefreelibrary.com]
- The medical term for excessive fluid in a joint is a "joint effusion." Gout frequently involves joints in the lower extremities. The classic location for gout to occur is the big toe.[medicinenet.com]
Joint Deformity
- Without treatment, joint deformation and limitation of movement can occur.[drlox.com]
- Chronic attacks can be destructive causing resorption and erosion of the bone, and can potentially cause joint deformities. Chronic tophaceous gout is induced by repeated attacks of gout over many years leading to tophies formation.[eldersarthritis.com]
- Surgery may be required to excise or drain infected or ulcerated tophi, to correct joint deformities, or to improve joint function.[medical-dictionary.thefreedictionary.com]
- Chronic symptoms such as joint deformity and limitation of motion in affected joints may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues.[mountsinai.org]
Knee Pain
- A 65-year-old male with a history of gout presented with bilateral knee pain. His radiographic imaging was negative for gouty tophi, and he elected to undergo left total knee arthroplasty.[ncbi.nlm.nih.gov]
- One month prior to admission, he presented with right knee pain and swelling. Blood cultures grew S. epidermidis . He was treated for presumed septic arthritis complicated by MSSE bacteremia.[the-rheumatologist.org]
- CPPD can have symptoms resembling that of gout and can also occur concomitantly in up to 40% of patients with gout. 9 Our patient who was on long duration of treatment for gouty arthritis presented to our clinic with nonspecific knee pain and an incidental[appliedradiology.com]
- pain is not particularly common, it should always be considered with any sudden incidence of knee pain associated with swelling and redness.[knee-pain-explained.com]
Workup
- Gout and Pseudogout Workup. Available online at . Accessed 6/20/2017. National Institute of Arthritis and Musculoskeletal and Skin Disease. 2016. Questions and Answers about Gout. Available online at . Accessed 6/20/2017.[labtestsonline.org]
- Classic radiographic findings are highly suggestive (see Workup ).[emedicine.com]
X-Ray
Nephrolithiasis
- 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.[ncbi.nlm.nih.gov]
- ., renal insufficiency, urate nephropathy, nephrolithiasis), and cardiovascular events (i.e., myocardial infarction, heart failure, ischemic stroke).[ncbi.nlm.nih.gov]
- The association between gout and nephrolithiasis in men: The Health Professionals' Follow-Up Study. Kidney Int . 2003;64:1022-1026. Schlesinger N, Detry MA, Holland BK, et al. Local ice therapy during bouts of acute gouty arthritis.[primeinc.org]
- Urate-lowering agents ("Remove the matches from the body") Allopurinol /Zyloprim 300 mg/day PO usually (for hyperuricemia associated with overproduction, urin. uric acid excretion 700 mg/24h, nephrolithiasis, prophylaxis before chemotherapy,) Uricosuric[enotes.tripod.com]
- ZURAMPIC Prescribing Information At doses greater than 200 mg a day of ZURAMPIC with an XOI, the risk of renal-related adverse events and nephrolithiasis was higher and should not be used.[fda.gov]
Serum
Uric Acid Increased
- On follow-up, it was confirmed that as serum C3 level returned to normal, urinary excretion of uric acid increased and serum uric acid level decreased, thereby resolving the burning pain of the left big toe.[ncbi.nlm.nih.gov]
- Avoidance of uric acid-increasing drugs (e.g., diuretics, aspirin in low doses, cyclosporine, ethambutol). Alcohol consumption (especially beer!). Strive for normal weight.[lecturio.com]
- Quantification of urinary uric acid can indicate whether hyperuricemia results from impaired renal excretion (with low urinary uric acid), increased production (with high urinary excretion), or decreased GI excretion (again with high urinary excretion[merckmanuals.com]
- acid increases PDZK1 and ABCG2 expression in human intestinal cell lines via the TLR4-NLRP3 inflammasome and PI3K/Akt signaling pathway Mo Chen, Xiaoyong Lu, Ci Lu, Ning Shen, Yujie Jiang, Menglu Chen & Huaxiang Wu Arthritis Research & Therapy (2018)[nature.com]
- acid increases PDZK1 and ABCG2 expression in human intestinal cell lines via the TLR4-NLRP3 inflammasome and PI3K/Akt signaling pathway Mo Chen , Xiaoyong Lu , Ci Lu , Ning Shen , Yujie Jiang , Menglu Chen & Huaxiang Wu Arthritis Research & Therapy ([doi.org]
Treatment
- However, differences in renal function between the treatment and no-treatment groups were not statistically significant in any of the identified studies. CONCLUSION: Very limited data are available on the treatment of HU in asymptomatic patients.[ncbi.nlm.nih.gov]
- Factors associated with inadequate treatment were explored and post treatment renal function compared between A and ITGs. RESULTS: Of 139 patients, 46 (33%) achieved target serum uric acid concentrations.[ncbi.nlm.nih.gov]
- Allopurinol, febuxostat, and pegloticase are all effective treatments for controlling elevated uric acid levels after the treatment of an acute attack.[ncbi.nlm.nih.gov]
- Relative to on-demand treatment with intramuscular triamcinolone acetonide 40 mg, on-demand treatment with subcutaneous canakinumab 150 mg significantly relieved the pain and inflammation of a new gout flare, and reduced the risk of new flares in patients[ncbi.nlm.nih.gov]
- METHODS: We conducted a systematic literature review to determine what information is available to guide treatment decisions in this patient population.[ncbi.nlm.nih.gov]
Prognosis
- The Severe Gout of Emperor Charles V diff dx: gout attacks in the painful TKR pseudogout prognosis: arthritis remits completely and then recurs with increasing frequency; in a pt w/ h/o acute gout, there is an 86% occurance of recurrent acute attack 3[wheelessonline.com]
- MRI Signal characteristics of gouty tophi are usually: T1: isointense T2 variable 4 the majority of lesions are characteristically heterogeneously hypointense T1 C (Gd): tophus often enhances Treatment and prognosis Acutely, gout can be managed with non-steroidal[radiopaedia.org]
- Prognosis Nearly 90 percent of gout sufferers will experience some degree of kidney dysfunction as a result.[bbc.co.uk]
Etiology
- Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion of unknown etiology and is often accompanied by fever.[ncbi.nlm.nih.gov]
- The details of his illness and its possible etiology are reviewed. Inflammatory rheumatism was a descriptive term within which several modern diagnoses might be included.[dx.doi.org]
- On the dual etiology of hyperuricemia in primary gout. Arthritis Rheum. 1960 Oct; 3 :414–420. [ PubMed ] [ Google Scholar ] HOWELL RR, ASHTON DM, WYNGAARDEN JB. Glucose-6-phosphatase deficiency glycogen storage disease.[ncbi.nlm.nih.gov]
- There are five recognized stages of gout: asymptomatic hyperuricemia acute gouty arthritis intercritical gout (between acute attacks) chronic tophaceous gout gouty nephropathy Etiology The primary risk factor is hyperuricemia, although only a small proportion[radiopaedia.org]
Epidemiology
- Epidemiological data, serum uric acid level, and arthritis attacks were recorded at monthly follow-up visits. DECT of bilateral feet and ankles was performed at baseline and after 6 months of ULT.[ncbi.nlm.nih.gov]
- In this review, we discuss the epidemiology and risk factors for gouty arthritis and evaluate diagnostic strategies and therapeutic regimens for the management of gout, including a new drug approval. 2016 Pharmacotherapy Publications, Inc.[ncbi.nlm.nih.gov]
- In this article a detailed introduction, classification, epidemiology, risk factors, symptoms, diagnosis and treatment of gout with reference to modern and Unani system of medicines have been discussed.[ncbi.nlm.nih.gov]
- Various diagnostic criteria have been proposed for gout, depending on whether they are to be used in a clinical setting or for epidemiological surveys. 1 The criteria proposed by Bennett and Wood in 1968 2 are still helpful in routine clinical practice[dx.doi.org]
Sex distribution
Age distribution
Pathophysiology
- In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares. 2013 Chinese Orthopaedic Association[ncbi.nlm.nih.gov]
- METHODS: This review discusses the pathophysiology of acute gouty arthritis flares during initiation of ULT and examines the literature on the use of anti-inflammatory prophylaxis for reduction of these flares.[ncbi.nlm.nih.gov]
- […] of uric acid Radical dieting practices that involve starvation Secondary gout associated with drugs Secondary gout associated with other diseases: Diabetes Mellitus Hypertension Leukemia Myeloma Obesity Polycythemia Renal disease Sickle Cell Anemia Pathophysiology[rnpedia.com]
- […] and neutrophils followed by chronic gouty arthritis with tophi in joints and urate nephropathy Causes 2 - 5% of chronic joint disease Sites 50% have initial attack in first metatarsophalangeal joint; also ankles, heels, knees, wrists, fingers, elbows Pathophysiology[pathologyoutlines.com]
- Author information 1 Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachiouji, Tokyo 192-0392, Japan. ichida@toyaku.ac.jp Abstract ABCG2, also known as BCRP, is a high-capacity urate exporter, the dysfunction[ncbi.nlm.nih.gov]
Prevention
- OBJECTIVE: To systematically review available literature on treatment of hyperuricemia (HU) as a measure of preventing gouty arthritis, renal disease, or cardiovascular events in asymptomatic patients.[ncbi.nlm.nih.gov]
- Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout.[ncbi.nlm.nih.gov]
- OBJECTIVES: The management of gouty arthritis is focused on treating pain and inflammation associated with acute flares and preventing further acute flares and urate crystal deposition.[ncbi.nlm.nih.gov]
- RESULTS: MSW could significantly prevent the paw swelling and neutrophil infiltration induced by intra-articular MSU injection in rats.[ncbi.nlm.nih.gov]
- & control Opportunistic Infections/immunology Opportunistic Infections/prevention & control Practice Guidelines as Topic Recombinant Proteins/adverse effects Recombinant Proteins/pharmacology Recombinant Proteins/therapeutic use Severity of Illness Index[ncbi.nlm.nih.gov]