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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seven young adults with uric acid overproduction due to sickle cell anemia were normouricemic with a mean serum uric acid level of 4.9 mg/100 ml. Urate clearance was greater in these patients than in normal subjects or in patients with primary hyperuricemia due to uric acid overproduction. The increase in urate clearance was entirely accounted for by increased pyrazinamide suppressible urate clearance. Pyrazinamide administration abolished the uricosuric response to ribonucleic acid (RNA) feeding in these patients with sickle cell anemia, and maximal uricosuric response to the administration of probenecid was similar in the patients with sickle cell anemia and in normal subjects suggesting that reabsorption of both filtered and secreted urate was not impaired in sickle cell disease. Pyrazinamide suppressible urate clearance at maximal uricosuric response to probenecid was increased in patients with sickle cell disease suggesting increased tubular secretion of urate. This increase in urate secretion permits most young adults with urate overproduction due to sickle cell anemia to remain normouricemic and may account for the low frequency of secondary gout in this disease.
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PMID:Hyperuricosuria and increased tubular secretion of urate in sickle cell anemia. 110 19

This review of 65 black-black patients with gout, in contrast to tan or tinted, is presented to emphasize the universal nature of the disease, irrespective of race or geographic region. One case of a female who delivered a living child 4 yr after her initial attack of gout is reported. No case of gout secondary to chronic renal disease, or to a blood dyscrasia, including sickle cell disease, was discovered. Except for the race, aberrant sex distribution and low incidence of urate stones, this series is not unlike a series of white gout patients.
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PMID:Gouty arthritis in the black race. 112 98

A nearly 72-old black male with sickle cell anemia suffered from heart failure, hypertension, chronic impaired kidney function with hyperuricemia and gout. Anoxemia due to refractory anemia of the sideroachrestic type most probably precipitated the sudden heart failure.
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PMID:Long survival in sickle cell anemia. 113 54

Between December 15, 1988 and November 30, 1990, the application of Rome and New York criteria enabled the diagnosis of 60 cases of gout among patients with arthritis or hyperuricemia seen as out-patients or hospitalised in the Department of Rheumatology of the Brazzavile T.H.G. There were 57 men and 3 women, with a mean age of 51. Gout is the primary form of inflammatory arthropathy in adults in the Congo. Affecting all socio-professional groups, it is diversely associated with obesity, alcoholism, hypertension and diabetes. Initial involvement affects the big toe. Oligo and polyarticular forms predominate because of the absence or delay in specific treatment. This series included 30 per cent of cases of chronic gout. Evidence of renal impairment was found in one third of patients. However, urate lithiasis was absent. Tophi were found preferentially over the elbows. Sickle cell disease was responsible for one case of tophaceous gout. In contrast with the results of studies undertaken before the 1980s, gout is seen to be a common condition in equatorial Africa.
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PMID:[Epidemiological and clinical aspects of gout in equatorial Africa. Apropos of 60 cases followed in the Department of Rheumatology of the Teaching Hospital Center in Brazzaville]. 178 Jun 67

During a study of clinical and laboratory features in 83 patients with sickle cell disease in the Netherlands, serum creatinine, sodium, potassium, uric acid and osmolality were determined and reported for 65: 39 with homozygous sickle cell (SS) disease, 5 with beta degrees thalassaemia (S beta degrees thal), with sickle cell beta + thalassaemia (S beta degrees + thal) and 17 with sickle cell haemoglobin C (SC) disease. Data on history of hyposthenuria was unreliable. Haematuria was reported in 6 (7%) of the 83 patients. Four of the six patients with a history of haematuria, two of whom had elevated creatinine levels, had SS disease. Lower mean levels of serum sodium and higher levels of serum potassium were observed in SS's than in the other genotypes (p less than 0.001). Hyperkalaemia of greater than 5 mmol/l was seen in 50% of SS disease cases and in 33% of paediatric SC disease cases. Some high potassium levels must be ascribed to in vitro haemolysis. The rate of hyperuricaemia ranged from 24% to 40% among the various genotypes. Clinical gout was not observed.
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PMID:Renal and electrolyte profile in steady state sickle cell disease: observations in patients with sickle cell disease in The Netherlands. 276 58

Aseptic necrosis of the femoral head is a well-defined entity. The underlying diseases originate from very different types of pathological conditions. Alcoholism, cortisone therapy, gout or hyperuricemia, sickle cell anaemia and others all lead, through various pathways, to the impairment of the medullary blood flow. In many instances, a compartment syndrome can be demonstrated in the femoral head. Death of the osteocytes follows bone marrow necrosis. Revascularisation originates in the periphery of the necrotic segment. Vascular buds and fibroblasts invade the medullary space. New bone is laid over the necrotic trabeculae. Mechanical failure results from changes in the bony framework at three different levels. The subchondral boneplate may be weakened by the process of revascularisation, the necrotic trabeculae may fail because of diminished stiffness and strength, and overloading has been demonstrated at the junction between dead and living bone. Elevation of the intramedullary pressure is the first objective sign of impending or established bone necrosis. Scintigraphy with Technetium 99 m - Sulphur colloid can now show the early stages of marrow necrosis. Roentgenographic changes only appear in a later phase of the disease. Aseptic necrosis must be considered as involving both hips, unless proven otherwise. Attention given to the "silent hip" may allow salvage and prevent the occurrence of osteo-arthritic changes leaving merely unilateral disease. As long as the geometrical shape of the femoral head is maintained operation may well prove useful. The aim at this stage is to prevent collapse. It is impossible to know in the early stages whether mechanical failure will occur, but there is general agreement that the femoral head will eventually undergo deformation. A spherical epiphysis is therefore considered a success. All the conservative methods aim to decompress the medullary cavity. Core biopsy, curettage, bone grafting and intertrochanteric osteotomy all have their advocates. After fracture of the subchondral bone plate has occurred, there is evidence that grafts are unable to restore the strength of the necrotic area. Intertrochanteric osteotomy brings under the main load-bearing zone a vital part of the femoral head. Varus osteotomy can be successful if necrosis has spared sufficient of the lateral portion of the head. Rotation osteotomies, as proposed by Sugioka, are more radical and difficult operations. The published results are promising. Revascularisation of the weight-bearing area by pedicle grafts has been attempted, alone or in addition to osteotomy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Aseptic necrosis of the femoral head in young adults]. 638 8

Arthritis in association with sickle cell disease was seen in 37 patients in a 21/2-year period. Cases of gout and of avascular necrosis of the femoral head were excluded. In 12 patients a non-inflammatory effusion occurred during the course of a painful crisis, in 12 patients an ankle effusion occurred in association with spontaneous development or deterioration of leg ulceration, and in 13 patients there was a group of miscellaneous arthritides. Ankle arthritis with leg ulceration has not been previously recognised, and its association with spontaneous ulceration, which is presumed to have a vaso-occlusive origin, is compatible with ischaemic synovial damage. The aetiology may therefore be similar to that believed to account for effusions in association with the painful crisis.
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PMID:Non-gouty arthritis in sickle cell disease: report of 37 consecutive cases. 647 18

The infrequent occurrence of gout in patients with sickle cell anaemia contrast with the high incidence of hyperuricaemia and impaired renal function. This report records the third case of synovial membrane uric acid deposition and the first case of tophaceous deposits in haemoglobin SS patients. The limitations of a diagnosis of gout on the basis of hyperuricaemia and arthritis are confirmed. Analysis of reported cases suggests the existence of 2 forms of arthritis associated with sickle cell anaemia--noninflammatory and inflammatory. Paradoxically, gout appears to be associated with the former, in which the pathophysiological changes probably prevent or diminish the acute inflammatory response.
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PMID:Sickle cell disease associated with uric acid deposition disease. 743 65

This report describes the case of a 63-year-old obese and alcoholic butcher who suffered two episodes of distal oligoarthritis. These episodes were attributed to gout on the basis of response to colchicine and demonstration of hyperuricemia. Given the presence of hepatomegaly, splenomegaly and hyperleukocytosis, a sternal puncture and myelogram were performed and led to diagnosis of chronic myelogenous leukemia. In addition to the classic predisposing factors for gout, sickle cell anemia could be implicated in Black Africa. Longer life expectancy for patients with sickle cell anemia could increase the incidence of gout in Black Africa.
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PMID:[Chronic myeloid leukemia manifesting as gout. Reflections on secondary gout in Black Africa]. 756 98

There have been few epidemiological studies of bone and joint diseases in black Africa. Available data were generated by hospital studies which were inevitably flawed by selection bias. They found that the incidence and/or severity of rheumatoid arthritis were reduced in West Africa but not in urban areas of Southern and East Africa, as compared with industrialized countries. Ankylosing spondylitis was infrequent. The human immunodeficiency virus epidemic can be expected to increase the prevalence of spondyloarthropathies despite the fact that few black Africans are HLA B27-positive. Gout was the most common inflammatory joint disease seen in inpatients in West Africa and Equatorial Africa. Osteoarthritis of the fingers or hip and dysplasia of the hip were infrequent. The main causes of hip symptoms were sickle cell anemia and hemoglobin C disease whose manifestations include bone necrosis, osteomyelitis, and attacks of bone and joint pain. Osteoarthritis of the knee was common in West and Southern Africa, especially in obese women. Low back pain and sciatica due to disc herniation were as common as in Europe. Lumbar canal stenosis appeared more common in West Africa than in Southern Africa, with a predominance in females. Postmenopausal osteoporosis was exceedingly rare. Infectious diseases were prevalent as a result of underindustrialization and defective hygiene. The paucity of rheumatologists, young mean age of the population, and scarcity of population-based studies are sources of bias which should be taken into account when interpreting the available data on rheumatological diseases in black Africa. In the future, more rigorous studies made possible by increased access to health care will provide improved insight into the semiology and epidemiology of bone and joint diseases in this area.
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PMID:[Rheumatic diseases in black Africa]. 812 80


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