Background: Tophi gout refers to the condition, where consistently high level of uric acid in the body causes the deposition of uric acid or monosodium urate crystals on the joints. Objective: To describe clinical and subclinical features of tophi gout. Subjects and method: A study conducted in 51 patients with tophi gout (according to Bennett-Wood criteria - 1968) in Department of Rheumatology, Bach Mai hospital, from February 2005 to February 2006. This was a cross-sectional prospective study. Results: The average time of tophi appearance lasted 5.3 \xb1 5.7 years. The average number of tophi was 4.5 \xb1 3.9. The most common positions of tophi were tarso - metatarsal - phalangeal joints and elbow joints (43-47%). 100% had gouty arthritis (in which 66.6% > 4 joints), 50-55% involved tarso - metatarsal - phalangeal joints (43.1% had deforming joints). On X-ray, 62.7% cases has injuries, para-articular erosions and overhanging margins (62.5%), joints space narrowing (71.9%), proliferation osseous change (43.8%). Renal stones examined by ultrasound were 41%, renal failure 24.6%. Blood analysis showed hyperuricemia (88.2%), hypertriglyceridemia (54.9%), hyperglycaemia (13.6%). Conclusions: Common features tophi gout were injuries in tarso - metatarsal - phalangeal joints; gouty polyarthritis over 4 joints. X-ray images showed para-articular erosions, joints space narrowing, proliferation osseous changes.
Gout/ pathology ; diagnosis

Background: Tophi is an important symptom of chronic gout. Objective: To assess clinical characteristics of topbi and its relationships with other manifestations of chronic gout. Subjects and method: A study was conducted in 65 patients diagnosed chronic gout based on Bennett and Wood criteria 1968, with tophi, treated at Department of Rheumatology, Bach Mai hospital, from December 2003 to June 2004. This was a retrospective, prospective, cross-sectional study. Results and conclusions: All patients were males and the average age was 57.8 \xb1 11.71 years. 72.3% of patients aged from 30 to 59 years. The average time of occurrence of tophi in chronic gout was 7.73 years. The mean number of tophi was 24.8 \xb1 9.4 (ranged from 1 to 70). Erosion of tophi occurred 25%. 92.9% of patients had distribution in inferiors limbs and 80.4% had superior limbs. There were relationships between number of tophi and renal lesions, distribution of tophi and number of painful joints.
Gout/ pathology ; therapy

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its branches in the fibro-osseous tunnel beneath the flexor retinaculum. This pathology is associated with multiple etiologies, including trauma, space-occupying lesions, and impaired biomechanics. We report a case of tarsal tunnel syndrome associated with gout tophi in a patient with untreated gout along with a review of the relevant literature on tarsal tunnel syndrome.
Gout* ; Humans ; Pathology ; Tarsal Tunnel Syndrome* ; Tibial Nerve

A sixty-eight-year-old female presented with suddenly developed pain in the left knee joint. On the first visit, there was severe tenderness on the anterolateral aspect of the knee joint with active flexion and extension limited by pain. Radiographs revealed multiple round calcific masses in the anterolateral aspect of the knee joint. Under the impression of intraarticular lesions, we performed arthroscopic examination of the knee joint, which revealed no intraarticular pathology. The masses were found in the extracapsular soft tissue and we performed excisional biopsy of the masses completely. The masses were confirmed as tumoral calcinosis by histopathologic examination. It rarely occurs around the knee joint and is usually asymptomatic. Idiopathic tumoral calcinosis with acute symptoms must be differentiated from other pathologic conditions such as gout or infection. The clinical manifestation of this case was opposed to the previous reports. So we report a rare case of idiopathic tumoral calcinosis of the knee joint with acute symptoms.
Biopsy ; Calcinosis* ; Female ; Gout ; Humans ; Knee Joint* ; Knee* ; Pathology

Gout occurs mainly in monoarthritis and is found in more than 50% of cases in hallux of the foot. In addition, symptoms sometimes begin in the hand, wrist, and elbow, but they are rarely observed in the spine. The patient was referred for tuberculous polyarthritis due to antituberculosis drug failure. Inflammatory findings were observed in the lumbar, elbow, wrist, hand and foot areas. Surgery was performed on the foot area and a pathology diagnosis revealed gouty arthritis. We report this case with a review of the relevant literature.
Arthritis* ; Arthritis, Gouty* ; Diagnosis ; Elbow ; Foot ; Gout ; Hallux ; Hand ; Humans ; Pathology ; Spine ; Wrist

PURPOSE: To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). MATERIALS AND METHODS: Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. RESULTS: The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. CONCLUSION: In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.
Adult ; Aged ; Carpal Tunnel Syndrome/*diagnosis/*etiology/pathology ; Female ; Gout ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Tenosynovitis ; Tomography, X-Ray Computed ; Wrist/pathology/surgery

Calcium Pyrophosphate ; metabolism ; Cartilage, Articular ; metabolism ; pathology ; Chondrocalcinosis ; diagnostic imaging ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Gout ; pathology ; Humans ; Knee Joint ; diagnostic imaging ; metabolism ; pathology ; Male ; Menisci, Tibial ; metabolism ; pathology ; Middle Aged ; Osteoarthritis ; etiology ; pathology ; Radiography

Allopurinol is frequently used for the treatment of hyperuricemia and gout. Sometimes, a life-threatening reaction develops, as is illustrated by the following case report. We describe a 60-year-old male patient who was treated with allopurinol because of asymptomatic hyperuricemia, and he was presented with fever, skin rash, eosinophilia, worsening renal function and vanishing bile duct syndrome. In this report, we discussed vanishing bile duct syndrome as a serious side effect of allopurinol, and we briefly reviewed the etiology, prevention, and treatment modalities for vanishing bile duct syndrome.
Allopurinol/*adverse effects ; Bile Duct Diseases/*etiology/pathology ; Drug Hypersensitivity/*complications ; English Abstract ; Gout Suppressants/*adverse effects ; Humans ; Male ; Middle Aged

Hyperhomocysteinemia is one of the important factors of the cardiovascular disease, and gout is well known to be associated with cardiovascular disease. There are a few reports on the serum homocysteine (Hcy) levels in patients with gout, however, the results showed discrepancies. In this study, we measured Hcy levels in patients with gout and examined factors associated with the levels of serum Hcy. Ninety-one male patients with gout and 97 age-matched healthy male controls were enrolled in the study. Serum uric acid levels were not significantly different between gout and healthy control groups. However, serum Hcy levels were significantly higher in patients with gout compared to controls (13.96+/-4.05 microM/L vs 12.67+/-3.52 microM/L, P=0.035). In gout group, patients with 1-2 stages of chronic kidney disease (CKD) had significantly lower serum Hcy than those with 3-5 stages of CKD (13.15+/-3.46 microM/L vs 17.45+/-4.68 microM/L, P<0.001). Multivariate linear analysis revealed an inverse association between serum Hcy and estimated glomerular filtration rate (eGFR) (beta=-0.107, P<0.001). In conclusion, serum Hcy was elevated in male patients with gout. Hyperhomocysteinemia was not correlated with serum uric acid, but it was inversely associated with impaired renal function.
Glomerular Filtration Rate ; Gout/blood/*diagnosis ; Homocysteine/*blood ; Humans ; Hyperhomocysteinemia/blood/diagnosis ; Male ; Middle Aged ; Renal Insufficiency, Chronic/blood/pathology ; Severity of Illness Index ; Uric Acid/*blood

OBJECTIVETo study the relationship between syndrome type and the parameters of hemorrheology and platelet activation in patients with acute gout arthritis of dampness-heat blockage (DHB) type and stasis-heat accumulation (SHA) type.

METHODSForty patients with acute gouty arthritis were divided into 2 groups according to TCM syndrome differentiation, the DHB group (n=24) and the SHA group (n=16), and 20 healthy people were taken as the control group. Hemorrheological parameters, platelet activating factor (PAC-1) and P-selection (CD62p) in them were detected.

RESULTSPlasma viscosity, outcome of erythrocyte sedimentation and K value of its equation, levels of PAC-1 and CD62p were higher, erythrocyte electrophoresis index was significantly lower in gout patients of both types than those in the control group (all P < 0.01), and the levels of PAC-1 and CD62p in the SHA group were higher than those in the DHB group (P < 0.05).

CONCLUSIONDHB type and SHA syndrome type of acute gout arthritis are correlated with parameters of hemorrheology and platelet activation, and the different levels of these pameters showed in the two types, may be the internal factors for their genesis.

Acute Disease ; Adult ; Aged ; Arthritis ; blood ; pathology ; physiopathology ; Diagnosis, Differential ; Female ; Gout ; blood ; pathology ; physiopathology ; Hemorheology ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; P-Selectin ; blood ; Platelet Activating Factor ; metabolism ; Platelet Activation ; Syndrome