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

The patient who presents with an acute painful synovitis of a single joint provides a significant diagnostic and therapeutic challenge to the primary care physician. An aggressive approach is required to differentiate a potential infectious arthritis, with its attendant morbidity and potential mortality, from other causes of monarthritis that are not immediately life-threatening. This article reviews the common causes of acute monarthritis in the adult, including the presentation, as well as guidelines for rapid and efficient diagnosis and management. Common causes include infections (bacterial/Lyme/mycobacterial/viral), microcrystalline disease (gout/pseudogout), and traumatic and reactive arthropathy. In addition, guidelines are suggested for the management approach to acute monarthritis when initial diagnostic testing is unrevealing of a specific diagnosis.
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PMID:Common urgent musculoskeletal injuries in primary care. 1708 59

The aim of this study was to evaluate adverse and therapeutic effects of applicated holmium-boro-macroaggregates (HBMAs) in the radiosynoviorthesis (RSO) of knees in patients suffering from chronic synovitis. We started RSO of the knees by means of a new radiopharmaceutical (RF) HBMA in patients with gonarthrosis, rheumatoid arthritis, chronic synovitis, psoriatic arthritis, and gout arthropathy. Seventeen (17) intra-articular injections were performed in 15 patients who were receiving a mean activity of 972 MBq (range, 904-1057) of 166Ho-HBMA. Patient inclusion to the study followed a series of inclusion and exclusion criterions. The patients were hospitalized for 3 days. Side-effects were evaluated during their hospital stay and again after 6-8 weeks. Static scintigraphy of knee joints and measurements of blood radioactivity were performed. Therapeutic effects were evaluated after 6-8 weeks and at 6 months. In 2 hours and 2 days following the application, we proved, by means of knee and inguinal scintigraphy, only insignificant radiopharmaceutical leakage from the joint cavity to the inguinal lymph nodes in 4 patients. In the treated patients, no serious adverse effects occurred. Nine (9) patients were without complaints, 4 patients had slight knee exudation, and 2 patients had great exudation. Therapeutic effects were as follows: 2 patients were without pain, 9 were with lower pain, 3 were with the same pain, and 1 patient was with increased pain. Joint motion was improved in 7 patients, remained the same in 7 patients, and was impaired in 1 patient. Analgesics consumption was lower in 5 patients, the same in 9 patients, and greater in 1 patient. Knee exudation was absent in 2 patients, lower in 4 patients, the same in 6 patients, and greater in 3 patients. In 3 patients it was necessary to do surgical RSO. This RF can extend the range of clinically used radiopharmaceuticals for RSO and to supplement space between 90Y with high energy and 186Re with 169Er with lower beta energy. The energy of 166Ho is suitable for great and medium joints (i.e., knees, hips, shoulders, elbows, wrists, and ankles).
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PMID:Radiosynoviorthesis of knees by means of 166Ho-holmium-boro-macroaggregates. 1760 Apr 79

This review aims to provide an update of the currently available data regarding ultrasound (US) imaging in crystal-related arthropathies (CA). US imaging allows the assessment of patients with CA showing synovitis, bone erosions, tendon, bursal and cartilage pathology. Moreover, the conformation and anatomical location of crystals may help distinguish the different clinical entities, improving the accuracy of diagnosis and sensitivity of disease activity and therapy monitoring. Future topics for study include: consensus on scanning protocols and scoring systems, evaluation of greyscale and power Doppler US in the therapy monitoring of gout and evaluation of the role of 3D US in CA.
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PMID:Ultrasound imaging for the rheumatologist X. Ultrasound imaging in crystal-related arthropathies. 1788 4

Aim. To evaluate the reasons for atypical sequelae of knee arthroscopy.<br /> Material. A group of 11 patients (6 women and 5 men), age 17-56 (mean 33.4), referred for rheumatological consulation because of persistent exudates and/or pain in the operated joint. Infectious arthritis, rheumatoid arthritis, psoriatic arthritis and gout were excluded. Immunological diagnostics were performed on all patients, testing for the presence of anti-Chlamydia trachomatis, anti-Yersinia enterocolitica, anti-Salmonella enteritidis and typhimurium antibodies.<br /> Results. In 10/11 patients various antibodies were detected (most often anti-Chlamydia trachomatis antibodies). Other reasons for atypical sequelae of knee arthroscopy included pigmentous villo-nodular synovitis and chondrocalcinosis. The Discussion presents those clinical symptoms and signs appearing in orthopedic examinations that serve as indications for rheumatological consultation.<br /> Conclusion. The most common reason for atypical sequelae of knee arthroscopy is reactive arthritis caused by Chlamydia trachomatis and G(-) enteric bacteria infections.
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PMID:Atypical sequelae of knee arthroscopy and reactive arthritis. 1798 83

We report a case of acute gouty synovitis after total knee arthroplasty (TKA) in a patient with no history of gout. The diagnosis was confirmed by the presence of urate crystals in the synovial fluid. Acute gouty synovitis, though rare, should be considered in the differential diagnosis of an inflammed knee after TKA to avoid unnecessary surgical revision.
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PMID:Gouty synovitis after total knee arthroplasty: a case report. 1816 93

This review will suggest an algorithm for standardised histopathological diagnosis of synovial biopsies and synovectomy specimens. In principal, changes of the synovial membrane can be inflammatory or non-inflammatory. To the latter group belong some benign tumors, such as tenosynovial giant cell tumor, lipoma or synovial chondromatosis. Rare non-inflammatory changes are the group of storage diseases. Inflammatory synovial diseases can be differentiated into crystal-induced arthropathy, such as gout and pseudogout, granulomatous diseases, such as tuberculosis, sarcoidosis and foreign body reactions and into the large group of non-granulomatous synovitis. This last group is by far the most common and often causes difficulties in assigning the histopathological findings to a definite diagnosis. Therefore, the synovitis score should be applied in these cases as a diagnostic means, leading to the diagnosis of low-grade synovitis (which is associated with degenerative and posttraumatic arthropathies) or high-grade synovitis (associated with rheumatic diseases), the sensitivity and specificity being 60.5% and 95.5%, respectively. In detritus synovitis the synovitis score is not applicable.
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PMID:[Diagnostic spectrum of synovitis]. 1821 Jan 34

The management of acute gout, and other acute microcrystalline arthritides, can be difficult in aged patients, and in those with multiple medical illnesses contraindicating therapy with either nonsteroidal anti-inflammatory drugs or colchicine. Intra-articular corticosteroid therapy is particularly useful for the treatment of acute mono-or oligo-articular micro-crystalline synovitis in these patients. Oral corticosteroids (e.g., prednisone), and both parenteral corticotrophin (adrenocorticotrophic hormone) (ACTH) and corticosteroids (e.g., triamcinolone acetonide, methylprednisolone acetate), are useful alternate treatment modalities in those patients with acute polyarticular attacks. Although ACTH has demonstrated comparable clinical efficacy to corticosteroids in the treatment of acute micro-crystalline events, corticosteroids are preferred by many physicians for many reasons: administration can be oral, dose can be regulated precisely, effectiveness does not depend on adrenocortical responsiveness, and incidence of certain side effects, such as hypertension and fluid overload, is lower.
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PMID:Current therapy of acute microcrystalline arthritis and the role of corticosteroids. 1907 15

Immune reconstitution inflammatory syndrome (IRIS) describes the initial clinical deterioration some patients manifest upon initiation of effective antiretroviral therapy (ART) for HIV infection. In this report we describe a case of IRIS manifesting as polyarticular gout, a previously unreported rheumatological manifestation of IRIS. A 53-year-old HIV-infected man with a history of intermittent attacks of gout and an initial CD4 count of 112 cells/microL and a viral load of >100,000 copies/mL presented to our institution with severe, refractory, polyarticular gout approximately 4 weeks after initiating ART. At this point, the patient demonstrated significant gains in his CD4 counts (103 cells/microL) and a greater than 3 log decline in his HIV-1- viral load. This episode was prolonged lasting for approximately 10 weeks and required hospitalization for the management of pain and control of inflammation. The temporal associations of this attack with the initiation of ART and the observed immunologic reconstitution make IRIS a clinical possibility.Monosodium urate crystals through their interactions with interleukin 1- beta, and neutrophilic synovitis play a critical role in the pathophysiology of gout. Defects in both neutrophil and macrophage function and imbalances in the cytokine milieu are documented in HIV infected patients. The introduction of ART results in restoration of neutrophil and macrophage function, declines in levels of the anti-inflammatory cytokine IL-10, and increases in levels of proinflammatory cytokines including IL-1 beta, which may provide the necessary milieu for the precipitation of attacks of severe polyarticular gout in the context of ART initiation.
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PMID:Refractory polyarticular gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome. 2005 57

Gout is a disorder of purine metabolism, of varied etiology, associated with an increase in serum uric acid and a recurrent arthritis. The defect may be either metabolic or renal, or either unknown etiology or associated with other disease states. The acute arthritis has been shown to be due to a crystal (sodium urate) synovitis. The many chronic complications, arthritic, renal and vascular, necessitate a vigorous and longterm treatment program. With the advent of the xanthine oxidase inhibiter Allopurinol, excellent control of gout and its complications can be achieved in a large number of patients, with good control in the remainder.
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PMID:Gout: current concepts and treatment. 2046 63

The diagnosis of gout is usually based on clinical presentation and laboratory findings. Imaging plays a role in the assessment and grading of articular damage related to chronic, long-standing disease, which is characterized by granulomatous synovitis, tophi, and erosions. Multimodality imaging of chronic tophaceous gout may be useful in clinical practice for a variety of purposes, including assessment of disease-related anatomical changes and monitoring of articular and soft-tissue lesions over time, especially in response to urate-lowering therapy. Radiography remains the primary imaging technique. Ultrasonography may detect monosodium urate crystals on cartilage, is helpful to assess small joint effusion, to guide to joint aspiration, and to evaluate the volume of tophi. Computed tomography is considered to be more sensitive than plain radiography in the detection and evaluation of cortical bone erosions associated with tophi. MRI represents the only imaging modality which provides visualization of bone marrow oedema associated with erosions and may be useful to characterize and distinguish tophi from other soft tissue nodules.
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PMID:[Multimodality imaging of chronic tophaceous gout]. 2125 23


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