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

Gout is the most common inflammatory arthropathy for men. Asymptomatic hyperuricemia, which should lead to diet, but not to medication, is much more common still. Increased uric acid levels mostly result from diminished renal excretion, which is more commonly familiar than secondary (renal failure, diuretics). With the first episode of often typical (red, hot, exquisitely painful first MTP joint) acute arthritis or with urate nephrolithiasis, increased uric acid turns pathological. Attacks are treated with NSAIDs or corticosteroids. More common attacks, chronic gout, or urate nephropathy are definite indications for long-term (at least 5 years) therapy with allopurinol or febuxostat. Additional anti-inflammatory medication will be necessary during the first months. Calcium pyrophosphate deposition arthropathy, the second common crystal-induced arthritis, is diagnosed by synovial fluid analysis or for chondrocalcinosis. Treatment for attacks resembles therapy of acute gout; causal therapy is possible in case of secondary forms (e.g. hypothyroidism. hyperparathyroidism, hemochromatosis).
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PMID:[Crystal-induced arthritis--old but important]. 1756 56

In the acute stage of gout, the hallux is most commonly involved followed by the mediotarsal joints and the Achilles tendons. Diagnosis of gout is established when typical monosodium urate crystals can be identified. Apart from NSAIDs, colchicine can be used when there is no renal impairment. Hypouricemic agents (allopurinol or uricosuric drugs) must be initiated one or two weeks after the acute attack of gout because there are risks of exacerbation. Losartan as well as fenofibrate have uricosuric properties. Chondrocalcinosis of the foot can be observed in hemochromatosis. Diffuse idiopathic skeletal hyperostosis (DISH) can cause severe talagia. Hypercholesterolemia can induce xanthomas of the Achilles tendons. Apatite rheumatism can be observed in chronic dialysis patients.
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PMID:[Involvement of the foot in metabolic diseases]. 1792 16

If acute arthritis occurs in the elderly in addition to typical degenerative, load-related joint complaints, this is often induced by crystal deposition. The crystals lead to activation of the immune system resulting in acute inflammation. In addition to gout, calcium pyrophosphate deposition (CPPD) disease in particular must also be taken into consideration. Diagnostically important are imaging techniques, e.g. early specific alterations of cartilage can be shown by joint sonography and later calcium pyrophosphate crystals can be detected as cartilage calcification (chondrocalcinosis) by radiography. Important for the diagnosis of crystal arthropathy is usually the microscopic detection of specific crystals in the synovial fluid and is supported by exclusion of septic arthritis by arthrocentesis. In contrast to gout, which can be well controlled by the pharmaceutical lowering of uric acid levels, there is no causal therapy for CPPD disease so far. As CPPD may occur as a secondary effect in metabolic disorders, such as hyperparathyroidism or hemochromatosis, it seems to be important to search for the underlying disease. The following article presents the current knowledge on clinically relevant aspects of the pathogenesis, diagnosis and therapy of CPPD disease.
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PMID:[Chondrocalcinosis due to calcium pyrophosphate deposition (CPPD). From incidental radiographic findings to CPPD crystal arthritis]. 2481 59

This update develops the actual therapeutic options in the management of the joint involvement of calcium pyrophosphate deposition disease (CPPD), basic calcium phosphate (BCP) deposition disease, hemochromatosis (HH), ochronosis, oxalosis, and Wilson's disease. Conventional pharmaceutical treatment provides benefits for most diseases. Anti-interleukine-1 (IL-1) treatment could provide similar results in CPPD than in gout flares. There is only limited evidence about the efficacy of preventive long-term colchicine intake, methotrexate, and hydroxychloroquine in chronic CPPD. Needle aspiration and lavage have satisfactory short and midterm results in BCP. Extracorporeal shockwave therapy has also proved its efficacy for high-doses regimes. Phlebotomy does not seem to have shown real efficacy on joint involvement in HH so far. Iron chelators' effects have not been assessed on joint involvement either, while IL-1 blockade may prove useful. NSAIDs have limited efficacy on joint involvement of oxalosis, while colchicine and steroids have not been assessed either. The use of nitisinone for ochronotic arthropathy is still much debated, but it could provide beneficial effects on joint involvement. The effects of copper chelators have not been assessed either in the joint involvement of Wilson's disease. NSAIDs should be avoided because of the liver affection they may worsen.
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PMID:Treatment of nongout joint deposition diseases: an update. 2489 35

An adult male channel-billed toucan (Ramphastos vitellinus) was presented with a history of weakness, dyspnea, and severe dilatation of the coelomic cavity, which was caused by accumulation of serohemorrhagic fluid. Radiographs revealed increased radiodensity and thickness of the descending aorta and a pectoral mass, and blood test results revealed anemia, hypocalcemia, hypoproteinemia, and hyperuricemia. On ultrasound examination, a hyperechoic enlarged soft tissue mass was found in the caudodorsal region of the coelom. The bird did not respond to supportive care and died. Postmortem examination revealed severe, bilateral nephromegaly due to multifocal to coalescing renal tubular adenomas (adenomatosis), which was complicated with renal gout and soft tissue mineralization. Relevant concurrent diseases included hepatic hemochromatosis, subcutaneous cestodiasis with cellulitis, and systemic amyloidosis. There are few documented cases of neoplasms in ramphastid birds and to our knowledge, this is the first report of a renal neoplasm in a channel-billed toucan.
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PMID:Bilateral Renal Tubular Neoplasm in a Channel-billed Toucan (Ramphastos vitellinus). 2586 66

Calcium pyrophosphate deposition disease (CPDD) is a type of arthritis caused by the deposition of calcium pyrophosphate crystals, and may present as either acute or chronic arthritis. Development of CPPD crystal deposition disease in young people may be associated with metabolic diseases such as hemochromatosis, hyperparathyroidism, hypomagnesemia, Wilson's disease, hypothyroidism, gout, acromegaly, and X-linked hypophosphatemic rickets. Therefore, investigations for a predisposing metabolic condition are advised in young-onset polyarticular CPPD crystal deposition disease. In this article, we report two young patients who were investigated for recurrent joint pain due to CPPD disease.
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PMID:Calcium Pyrophosphate Dihydrate Deposition Disease in Young Patients: Two Case Reports. 3037 21


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