No abstract available.
Gout/*diagnosis ; Homocysteine/*blood ; Humans ; Male ; Uric Acid/*blood

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

Serum creatinine level is the most commonly used indices for assessment of glomerular filtration rate (GFR), even though these indices have been shown to have some limitations in clinical practice. We investigated the diagnostic efficacy of serum cystatin C compared to that of serum creatinine levels and identified the relating factors associated with changes in serum cystatin C levels in gout patients with renal impairment. A total of 68 gouty patients with renal impairment were enrolled in this study. Diagnostic efficacy of serum cystatin C levels was evaluated through non-parametric receiver operating characteristic (ROC) analysis. The risk factors for changes in serum cystatin C levels were confirmed using multivariate regression analysis. With 24-hr urine creatinine clearance (Ccr) as the reference for GFR, 1/cystatin C (r=0.702, P<0.001) showed a significantly higher correlation with Ccr than 1/creatinine (r=0.665, P<0.001). Multivariate correlation analysis demonstrated that the clinical parameters for increased serum cystatin C are a higher stage of chronic kidney disease, older age, use of allopurinol, and lower high density lipoprotein-cholesterol. The area under the curve (AUC) at ROC plots identified that of serum cystatin C was significantly greater than that of serum creatinine (AUC 0.804 of cystatin C and AUC 0.745 of creatinine). The study suggests that serum cystatin C is a reliable endogenous marker for the assessment of renal function or GFR in gout patients with renal impairment.
Age Factors ; Aged ; Allopurinol/therapeutic use ; Area Under Curve ; Biological Markers/metabolism ; Cholesterol, HDL/blood ; Creatinine/blood/urine ; Cystatin C/*blood ; Glomerular Filtration Rate ; Gout/complications/*diagnosis ; Gout Suppressants/therapeutic use ; Humans ; Male ; Middle Aged ; ROC Curve ; Renal Insufficiency/complications/*diagnosis ; Risk Factors

The aim of this study was to observe the effects of uric acid lowering therapy (UALT), febuxostat and allopurinol, on blood pressure (BP) and serum creatinine level. Post-hoc data were derived from a phase-III, randomised, double-blind, 4-week trial of male gouty patients that compared the safety and efficacy of febuxostat and allopurinol in adults with gout. The subjects were randomly assigned to one of five groups, 35-37 in each group (febuxostat: 40, 80, 120 mg/d; allopurinol: 300 mg/d; control group: placebo). Blood pressure and serum creatinine level were measured at baseline and at weeks 2 and 4. Diastolic BP and creatinine level had decreased significantly in the UALT groups compared to the control group at week 4. Diastolic BP had decreased significantly in the allopurinol group and serum creatinine level had decreased significantly in the febuxostat groups at week 4. After adjusting for confounding variables, serum uric acid changes were found to be significantly correlated with changes in serum creatinine level but were not associated with changes in systolic or diastolic BP. UALT in gouty subjects significantly decreased diastolic BP and serum creatinine level. Changes in uric acid were significantly correlated with those in serum creatinine level, suggesting the feasibility of renal function improvement through UALT in gouty men.
Allopurinol/*administration & dosage ; Biological Markers/blood ; Blood Pressure/*drug effects ; Creatinine/*blood ; Dose-Response Relationship, Drug ; Gout/*drug therapy ; Gout Suppressants/administration & dosage ; Humans ; Hypertension, Renal/diagnosis/etiology/*prevention & control ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Thiazoles/*administration & dosage ; Treatment Outcome

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

PURPOSE: The purpose of this study was to describe the clinical and MR imaging features of acute gouty arthritis and to define the characteristic findings that would be helpful for differentiating acute gouty arthritis from septic arthritis. MATERIALS AND METHODS: The authors retrospectively studied seven patients who suffered from acute gouty arthritis. The MR imaging findings were analyzed by two musculoskeletal radiologists who focused on joint effusion, subchondral bone erosion, bone marrow edema, synovial thickening (regular and even, or irregular and nodular), and the soft tissue changes (edema or abscess). The clinical records of the patients were reviewed with regard to age and gender, the clinical presentation and the laboratory findings (serum uric acid, WBC, erythrocyte sedimentation rate, C-reactive protein and synovial fluid culture). RESULTS: The patients consisted of six men and one woman whose mean age was 41 years (age range: 24-65 years). The joints involved were the knee (n=6), and ankle (n=1). Two patients had medical histories of gouty attacks that involved the first metatarsophalangeal joint. In six cases, the serum uric acid level during acute attacks was elevated. In all the patients, the affected joint became swollen, hot, erythematous and extremely tender, and this was accompanied by a high ESR and a high C-reactive protein level at the time of presentation. The results of Gram stain and culture of the synovial fluid were negative. In all patients, the MR images showed large amounts of joint effusion, thick irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosions and soft tissue abscess. In one case, subchondral bone marrow edema of the medial femoral condyle was present. In five cases, there were multiple low signal foci in the joint on the spin-echo T2-weighted MR image. CONCLUSION: Even though the MR imaging findings of acute gouty arthritis are nonspecific, it should be considered as a possible diagnosis when a large amount of joint effusion, irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosion, bone marrow edema or soft tissue abscess are seen in the knee or ankle joint, and especially if this is accompanied by the clinical and laboratory features of infection.
Abscess ; Ankle ; Ankle Joint ; Arthritis ; Arthritis, Gouty* ; Arthritis, Infectious ; Blood Sedimentation ; Bone Marrow ; C-Reactive Protein ; Diagnosis ; Edema ; Female ; Gout ; Humans ; Joints ; Knee ; Magnetic Resonance Imaging* ; Male ; Metatarsophalangeal Joint ; Retrospective Studies ; Synovial Fluid ; Uric Acid

Allopurinol, a commonly prescribed medicine for the management of gout and hyperuricemia, may induce life-threatening hypersensitivity characterized by fever, eosinophilia, hepatitis, renal failure, and skin eruptions such as Stevens-Johnson syndrome or toxic epidermal necrolysis. Stevens-Johnson syndrome may rarely affect the gastrointestinal tract, associated with a poor prognosis. We have experienced a patient having allopurinol hypersensitivity syndrome (AHS) with esophageal ulcer bleeding. A 64-year-old man was admitted with ten-day history of widespread rash and fever. Six weeks before admission, he had symptoms of gouty arthritis, and he was treated with allopurinol and colchicine for 10 days. Complete blood count showed leukocytosis with eosinophilia and blood biochemistry showed impaired renal and hepatic function. The diagnosis of an AHS with Stevens-Johnson syndrome was made from the history and the typical clinical feature. Despite adequate hydration, steroid and immunoglobulin therapy, severe esophageal ulcer bleeding, sepsis and disseminated intravascular coagulation had been developed and the patient died 33 days after admission. Until now, there is no specific treatment for the AHS. The only means of minimizing the incidence of AHS is to limit the allopurinol therapy to accepted indications and to adjust the dosage for the patient's renal function.
Allopurinol* ; Arthritis, Gouty ; Biochemistry ; Blood Cell Count ; Colchicine ; Diagnosis ; Disseminated Intravascular Coagulation ; Eosinophilia ; Exanthema ; Fever ; Gastrointestinal Tract ; Gout ; Hemorrhage* ; Hepatitis ; Humans ; Hypersensitivity* ; Hyperuricemia ; Immunization, Passive ; Incidence ; Leukocytosis ; Middle Aged ; Prognosis ; Renal Insufficiency ; Sepsis ; Skin ; Stevens-Johnson Syndrome ; Ulcer*

Gout is a chronic, progressive inflammatory disease with intermittent arthritic flares, which should not be regarded as a minor inconvenience or nuisance. It can be effectively controlled when the patient's serum urate level is reduced to less than 360 μmol/l (6 mg/dL) by consistent use of urate-lowering pharmacotherapy. Colchicine prophylaxis for gouty flares during titration of urate-lowering therapy has been underused. Holistic long-term management of gout must encompass patient education, evidence-based dietary advice, screening and aggressive treatment of comorbidities such as hypertension, diabetes mellitus, dyslipidaemia and renal impairment. Acute therapies for recurrent attacks with non-steroidal anti-inflammatory drugs, colchicine and/or corticosteroids should be used judiciously, especially in the elderly, due to the risk of toxicities. With appreciation of the underlying pathogenesis and artful use of the limited drug options, control of gout can be effectively achieved, bringing tremendous satisfaction to the patient and doctor.
Adrenal Cortex Hormones ; therapeutic use ; Adult ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Chronic Disease ; Colchicine ; therapeutic use ; Gout ; diagnosis ; diet therapy ; drug therapy ; Humans ; Male ; Uric Acid ; blood