No abstract available.
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
Gout

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).
Gout

No abstract available.
Gout* ; Hyperuricemia

No abstract available.
Gout ; Humans

No abstract available.
Gout ; Light

No abstract available.
Gout ; Light

Gout in the sesamoid of the great toe is very rare, such that to our best knowledge, there have been only four reports internationally. We present a case of hallucal medial sesamoid gout in the respect of the literature review, clinical, pathological features and surgical outcome.
Gout* ; Toes

Background: Sodium bicarbonate is highly alkaline and may be helpful in relieving symptoms of gout. Sodium bicarbonate helps to adjust your body's pH level, slightly creating an alkaline-forming state that lessens the likelihood of gout attacks. We can prepare sodium bicarbonate in several ways to treat gout symptoms. Objective: To examine the efficacy of sodium bicarbonate for treatment of gout. Subjects and method: A study was conducted in 54 patients with gout at Department of Rheumatology of Bach Mai hospital, from September 2006 to March 2007. Patients were divided into two groups, group 1 included 29 patients treated with intravenous sodium bicarbonate and group 2 included 25 patients treated with oral sodium bicarbonate. This was a descriptive, cross-sectional study. Results: No significant changes showed between serum uric acid level, 24-hour urine uric acid level at before and after treatment in 2 groups. Gout patients with renal failure had increased level of 24-hour urine uric acid after treatment (p < 0.05). There were significantly increased level of urine volume, urine pH and decreased level of urine specific gravity after treatment. The effect of sodium bicarbonate was not different between intravenous usage and oral usage. Conclusion: Sodium bicarbonate could change urine environment, limit crystallization of urine uric acid of gout patients.
Gout/ therapy

No abstract available.
Diagnosis* ; Gout*