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

Rheumatic manifestations are common and varied in infective endocarditis. We performed a retrospective case analysis on 87 patients with 93 episodes of infective endocarditis admitted to Flinders Medical Centre over an 11 year period (1980-1990). Disabling musculoskeletal symptoms and signs were documented in 22 (25%) of the patients. Thirteen patients developed severe or moderately severe low back pain during their illness, two with radiological evidence of a septic discitis or vertebral osteomyelitis. Two patients developed polyarthralgia/arthritis, four had septic arthritis (all with acute Staphylococcus aureus endocarditis), three developed severe loin pain, two acute gout, two had severe buttock pain and sacroiliac joint tenderness and two each developed disabling jaw/facial pain, neck/scapular pain and flank pain respectively. Five patients presented initially to the orthopaedic or rheumatological unit for management of their musculoskeletal symptoms. Four of seven patients with Streptococcus bovis endocarditis demonstrated prominent low back pain supporting a previously noted association between this organism and back symptoms. Furthermore, in one patient who had three separate episodes of endocarditis involving three different organisms, florid back symptoms were only seen in the infective episode involving Streptococcus bovis.
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PMID:Rheumatic manifestations of infective endocarditis. 141 Oct 84

A 33-yr-old male ran 10 miles, drank some beer, and developed pain in his left knee and ankle. He took some leftover antibiotics but was no better after 6 d, when a heart murmur and an aortic valve nodule were discovered. He was presumed to have endocarditis with septic arthritis and was started on intravenous antibiotics. On the second hospital day, synovial fluid analysis revealed acute gout, and the patient improved very rapidly on anti-gout therapy. The valvular nodule remained unexplained, but one very rare cause of valvular heart nodules is visceral gout. An unsuccessful attempt to resorb the nodule was made by using allopurinol. This patient demonstrates several points about gout in endurance athletes: 1) acute gout can mimic infectious endocarditis, 2) misdiagnosed or undertreated gout often leads to multiple joint involvement and sometimes to visceral tophi, and 3) athletes who exercise in warm weather and quench their thirst with cold beer are at risk for acute gout.
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PMID:Runner with gout and an aortic valve nodule. 767 64

The aim of the study was analysis of clinical and laboratory markers of non-infectious thrombotic endocarditis (NITE) to facilitate differential diagnosis with infectious endocarditis (IE). 20 NITE patients (8 males and 12 females, mean age 32.3 years) were included in the trial. They had primary antiphospholipid syndrome, secondary antiphospholipid syndrome in systemic lupus erythematosus, nodular polyarteritis, nonspecific aortic arteritis, paraneoplastic NITE in lung and stomach cancer. NITE was also diagnosed in patients with gout and ankylosing spondylarthritis. Clinical and laboratory findings allow to differentiate IE with NITE. The former is characterized by destructive valvular lesions registered at echo-CG, positive hemoculture and arterial embolism. As a rule, NITE is associated with antiphospholipid syndrome and manifests with arterial and venous thrombosis, thrombocytopenia, livedo and presence of antibodies to cardiolipins.
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PMID:[Differential diagnosis of infectious and non-infectious thrombotic endocarditis]. 1175 99

Podagra is a term used to describe acute monoarthritis of the first metatarsophalangeal (1st MTP) joint. The most common diagnoses of arthritis in this joint are: crystal-induced synovitis, septic arthritis, traumatic conditions and reactive arthritis. When etiologies other than gout are involved this is frequently referred to as pseudopodagra. We report the case of a patient who presented with pain and swelling of the 1st MTP The absence of intraarticular crystals and hyperuricemia encouraged further evaluation of the patient. A cardiac murmur was investigated by echocardiography, which revealed valvular vegetations and the diagnosis of infective endocarditis (IE) was established. This is the first reported case of a podagra-like presentation of IE. As in this case, the diagnosis of gout should rest on findings beyond the presence at 1st MTP arthritis, with evaluation of all extraarticular signs in order to rule out other possible diagnoses.
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PMID:Pseudopodagra: A presenting manifestation of infective endocarditis. 1589

We present a case of Staphylococcus aureus septicaemia complicated with endocarditis and spondylodiscitis C2-C3 with compressive epidural mass in a 74-year old patient with a history of gouty arthritis and aortic prosthetic valve. Tophaceous material has been found when surgical decompression of the abscess has been performed. Staphylococcus aureus bacteremia is a serious and common infection with high mortality and complication rate. Amongst those complications, endocarditis is more likely to develop if cardiac prosthetic valve is present. The probability of a metastatic infection may be evaluated by several factors, such as: the time to positivity of blood culture, a community-acquired Staphylococcus aureus bacteremia and the presence of Osler nodes. All were present in our case. In fact, spondylodiscitis C2-C3 with compressive epidural mass was discovered, which was suspected to be an epidural abscess. Epidural abscess is a rare but potentially life-threatening disease that remains often underdiagnosed. Diagnosis is made by imaging and anatomopathological findings. In the case of our patient the finding of tophaceous material raises the issue of the nature of the epidural lesion. Spinal involvement with gout has been described. It can mimic epidural abscesses, most often in an infectious context as it was the case of our patient.
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PMID:[Staphylococcus aureus bacteremia and epidural mass in a patient with tophaceous gout]. 1964 94

Many rheumatic diseases show changes and are visible in the hands. The pattern of distribution in the relevant joints, soft-tissue changes, skin manifestations, neurological and vascular symptoms and clinical findings provide fundamental information. Imaging and lab results provide diagnostic support. In this review, common diseases are presented in terms of their clinical expressions in the hands: osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dihydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis, dermatomyositis/polymyositis and systemic lupus erythematosus. Furthermore, we discuss pathological findings of the hands as a result of diabetic cheiroarthropathia, endocarditis, secondary hypertrophic osteo-arthropathy and chronic regional pain syndrom.
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PMID:[The rheumatic hand - diagnostics in practice]. 2193 98

The polyarthritis is a relatively frequent situation which can translate a whole set of diverse and varied etiologies. A careful history and physica examination are key to accurate diagnosis of polyarthritis: the context, the topography of the articular involvement, the existence of general signs and extra-articular signs are crucial. It is advisable first of all to eliminate the infectious disease especially in case of fever (endocarditis). It is also necessary to look for a microcrystalline arthritis (gout, chondrocalcinosis) which the treatment justifies specific measures. Once these spread diagnoses, we can envisage an inflammatory rheumatism chronic and first of all, a rheumatoid arthritis (symmetric bilateral polyarthritis affecting hands and respecting distal interphalangeal joints). The rheumatoid arthritis is an urgency diagnosis: it requires an early, specialized, individualized and multidisciplinary care. The rapid institution of a disease-modifying antirheumatic drug can allow obtain a remission, mproves clinical outcomes and reduces the accrual of joint damage and disability.
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PMID:[The main directions in case of polyarthritis]. 2322 98

We review sessions on large-scale aspirin and anticoagulation trials, weight loss therapies, fish oil, gout, endocarditis, and cardiomyopathy, with important implications for health care providers.
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PMID:European Society of Cardiology Congress 2018. 3027 Nov 7