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

Allopurinol is used frequently to treat patients with gout and hyperuricemia. However, adverse effects associated with this agent have been reported occasionally, especially among patients with hyperuricemia complicated with renal diseases. A rise in the blood concentration of oxipurinol, the chief active metabolite of allopurinol, has been noted in patients with renal dysfunctions, pointing to an implication of oxipurinol toxicity. It has been reported that monitoring the serum oxipurinol concentration to maintain in level below 15.2 micrograms/ml (= 100 mumol/l: recommended level) is helpful in avoiding toxicity. At Jikei University Hospital, a survey was conducted on 148 hyperuricemic patients who had been treated with allopurinol at the dosages of 50, 100, 200 and 300 mg daily or 100 mg on alternate days for more than one month. Because oxipurinol is an uricosuric substance, the steady-state serum oxipurinol concentration was determined by HPLC; and creatinine clearance (CCr) was calculated for each patient. 1. In the group composed of patients with normal kidney function (CCr > or = 80 ml/min), increase in the dosage of allopurinol was associated with a linear increase in the serum concentration of oxipurinol. 2. Among the patients with varying renal function who were receiving 100 mg of allopurinol daily, the oxipurinol level increased logarithmically as the creatinine clearance decreased. In some of the patients with renal insufficiency (CCr < 30 ml/min), daily administration of 100 mg of allopurinol resulted in a serum concentration of oxipurinol over 15.2 micrograms/ml. 3. For patients with renal insufficiency (CCr < 30 ml/min), administration of allopurinol at the dosage of 50 mg/day is considered adequate to avoid the accumulation of serum oxipurinol.
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PMID:[A study of serum oxipurinol concentration and renal function in patients administered allopurinol]. 901 85

Primary gout is characterized by increased plasma and decreased urinary concentrations of hypoxanthine, xanthine and uric acid. To examine whether lead could explain the disturbance of purine metabolism in gout, we determined hypoxanthine, xanthine and uric acid metabolism and 5-day cumulative urinary lead excretion rates after an EDTA (calcium disodium edetate) test in 27 patients with primary gout and reduced creatinine clearance (C(cr)) and in 50 patients with gout and normal C(cr). The results were compared to those obtained in 26 normal subjects matched for age. All gout patients evidenced a marked renal underexcretion of hypoxanthine, xanthine and uric acid relative to their increased plasma levels. Purine metabolism was remarkably similar in both gout groups except for a significantly lower uric acid excretion in patients with reduced C(cr). Blood lead levels and cumulative lead excretion rates were significantly higher in gout patients with renal failure as compared to patients with normal C(cr). Fourteen patients (52%) with renal insufficiency and 6 (12%) with normal C(cr) showed increased lead excretion rates (95% Cl for the difference, 29-51%, p < 0.001). Mobilizable lead was not significantly correlated with serum or urinary purine concentrations. Hypoxanthine, xanthine and uric acid underexcretion was similar in gout patients with increased or normal cumulative lead excretion rates. The prevalence of atheromatosis and arterial hypertension together was significantly higher in gout patients with renal failure than in patients with normal C(cr) (81 vs. 60%, 95% Cl for the difference, 11-31%, p < 0.005). These results indicate that lead is not a significant contributor to the renal underexcretion of purines in gout. An increased mobilizable lead is not by itself evidence that lead is the cause of the renal insufficiency in patients with primary gout. Atheromatous nephropathy and/or nephroangiosclerosis may explain impaired renal function in patients with primary gout.
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PMID:Purine metabolism in patients with gout: the role of lead. 906 56

The purpose of this study was to determine the characteristics of gouty arthritis in an urban Guatemalan population. We reviewed the medical records of 148 (145 males and 3 females) patients with a diagnosis of acute gouty attack seen at an urban rheumatology clinic in Guatemala City between 1982 and 1993. Mean age at diagnosis was 49 years (range 21-87), mean age of onset was 42 years, mean duration of disease 7.4 years, family history of gout 42 (28%), peak prevalence 5th decade 39 (26%). Seventy-one (48%) had monarticular, 49 (33%) oligoarticular, and 22 (15%) polyarticular attacks, respectively. Podagra was seen in 34 (23%) patients; however, 108 (73%) developed it at any moment of their life. Tophaceous gout was seen in 33 (22%). Mean serum urate concentrations (enzymatic method) were higher than 7.0 mg % in 90 (60%) patients. At follow-up, 44 (30%) patients never returned to our clinic, and a large majority of them [66 (45%)] were seen only during acute attacks. Associated disorders included hypertension (43%), obesity (27%), nephrolithiasis (16%), ischaemic heart disease (7%), renal insufficiency (2%), stroke (0.6%), and diabetes mellitus (0.6%), and two died due to sepsis; high alcoholic intake was found in 58 (39%) patients. In conclusion, our findings indicate that gout is not an unusual disorder in the Guatemalan population. It presents with the same characteristics as those reported in Caucasians, with the possible exception of a lower frequency of diabetes mellitus as an associated disorder.
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PMID:Characteristics of gouty arthritis in the Guatemalan population. 913 25

Colchicine causes both muscle and peripheral nerve toxicity of subacute onset in patients with renal insufficiency. We report three cardiac transplant recipients, treated with colchicine for cyclosporin A (CyA)-induced gout, who developed acute weakness due to colchicine myoneuropathy. The onset of disabling weakness occurred over a 1-2 week period. All three patients had concomitant renal insufficiency and an elevated serum creatine kinase and two elevated CyA levels at the time of presentation. Electromyography revealed features of myopathy and motor axonal neuropathy in all three patients. Two underwent muscle biopsy which confirmed the presence of sarcoplasmic vacuoles characteristic of colchicine-induced myopathy. All patients rapidly improved with either colchicine dose reduction or drug discontinuation. In conclusion, cardiac transplant recipients treated with CyA and colchicine may be at increased risk of developing colchicine-induced myoneuropathy especially in the setting of concurrent renal insufficiency. In patients with post-transplantation gouty arthritis, other treatment modalities are suggested; and if colchicine is administered, the dose should be reduced, CyA levels should be monitored closely and patients should be assessed for signs of neuromuscular toxicity.
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PMID:Acute onset of colchicine myoneuropathy in cardiac transplant recipients: case studies of three patients. 949 3

The role of the kidney in hepatic disease and in gout has been surveyed. Kidney involvement is more common but less severe in hepatic disease, whereas it is less common but more severe in gout. The underlying pathology of the kidney lesions in both diseases (including studies by electron microscopy and immunofluorescence) is presented, with emphasis on the role this pathologic substratum plays in the renal insufficiency. The clinical aspects, including the diagnostic approach and therapeutic management of the "hepatorenal syndrome" and "gouty kidney" are discussed, as are the prognostic implications of the natural history of these "complications" and measures aimed at their prevention.
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PMID:The kidney in hepatic disease and in gout: clinical and pathologic aspects. 975 83

Gout in the elderly differs from classical gout found in middle-aged men in several respects: it has a more equal gender distribution, frequent polyarticular presentation with involvement of the joints of the upper extremities, fewer acute gouty episodes, a more indolent chronic clinical course, and an increased incidence of tophi. Long term diuretic use in patients with hypertension or congestive cardiac failure, renal insufficiency, prophylactic low dose aspirin (acetylsalicylic acid), and alcohol (ethanol) abuse (particularly by men) are factors associated with the development of hyperuricaemia and gout in the elderly. Extreme caution is necessary when prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute gouty arthritis in the elderly. NSAIDs with short plasma half-life (such as diclofenac and ketoprofen) are preferred, but these drugs are not recommended in patients with peptic ulcer disease, renal failure, uncontrolled hypertension or cardiac failure. Colchicine is poorly tolerated in the elderly and is best avoided. Intra-articular and systemic corticosteroids are increasingly being used for treating acute gouty flares in aged patients with medical disorders contraindicating NSAID therapy. Urate-lowering drugs are indicated for the treatment of hyperuricaemia and chronic gouty arthritis. Uricosuric drugs are poorly tolerated and the frequent presence of renal impairment in the elderly renders these drugs ineffective. Allopurinol is the urate-lowering drug of choice, but its use in the aged is associated with an increased incidence of both cutaneous and severe hypersensitivity reactions. To minimise this risk, allopurinol dose must be kept low. A starting dose of allopurinal 50 to 100mg on alternate days, to a maximum daily dose of about 100 to 300mg, based upon the patient's creatinine clearance and serum urate level, is recommended. Asymptomatic hyperuricaemia is not an indication for long term urate-lowering therapy; the risks of drug toxicity often outweigh any benefit.
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PMID:Gout in the elderly. Clinical presentation and treatment. 978 27

A 35-year-old patient with severe gout and mild renal insufficiency presented very low urinary urate excretion. Volume expansion induced by fludrocortisone combined or not with a uricosuric drug (Benzbromarone) was unable to significantly increase his urate excretion. A combined Probenecid (PB) and Pyrazinamide (PZA) test was performed. These drugs being considered to affect renal tubular reabsorption or secretion. No significant modification of uric acid fractional excretion (FE.uric acid) was observed after PB and PZA. When the same test was performed after the administration of Triglycyl-lysine vasopressine (TGLV), a potent V1 receptor stimulator, we observed a three fold increase in FE.uric acid after PB intake (from 6 to 18%) followed by a decrease after PZA (from 18 to 5.6%). When TGLV was administered alone their was no significant modification of uric acid fractional excretion. We propose that TGLV decrease proximal tubular urate reabsorption that could only be detected when postsecretory reabsorption is blocked by an uricosuric drug.
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PMID:Restoration of the uricosuric effect of probenecid after triglycylvasopressine administration in a gouty patient. 979 74

The clinical features and laboratory findings of 91 Thai patients (33 males and 58 females) with CPPD crystal deposition disease were studied. Their average age was 71.54 years. Acute monoarthritis and oligoarthritis were the two most common forms of presentation and were seen in 89 per cent of cases. The knee, wrist and ankle were the three most common joints involved. Associated diseases were common and included hypertension (30 cases), renal insufficiency (23 cases), chronic obstructive pulmonary disease (17 cases), coronary heart disease (13 cases) and diabetes mellitus (12 cases). Eleven patients had malignancies. Five patients had concomitant gout and CPPD crystal deposition disease. The knee and the wrist were the two most common sites of chondrocalcinosis. Of 67 patients who had thyroid function tested, 2 had hyperthyroidism and 5 had hypothyroidism. Hypomagnesemia was seen in 19 per cent. None had hypercalcemia, hypophosphatasia, hemochromatosis or hyperparathyroidism. In contrast to the western series, acute arthritis in our series responded well to oral colchicine alone.
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PMID:Calcium pyrophosphate dihydrate crystal deposition: a clinical and laboratory analysis of 91 Thai patients. 1044 78

Hyperuricemia and gout are known to occur in patients receiving diuretic therapy. More recently recognized, however, is the occurrence of tophaceous gout in patients treated with cyclosporine. We report a 57-year-old man with normal renal function who was started on cyclosporine immediately after undergoing bilateral lung transplantation. Six months later, he developed progressive renal insufficiency and hypertension. In the following four months (10 months after starting his immunosuppressant medication), he presented with a symmetrical distribution of tophi on his finger pads. Seven previous cases of finger pad tophi have been reported and are reviewed.
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PMID:Finger pad tophi. 1054 76

In an endeavor to analyse the clinical characteristics of female gout, we reviewed 36 women with gout. Twenty-seven (75%) developed the first symptomatic episode of gout after the onset of the menopause. The mean age at onset of gout was 54.3 years (range 15-87 years). Twenty-two patients (61%) had hypertension, 17 (47%) had renal insufficiency, 13 (36%) used diuretics and 10 (28%) were taking cyclosporine for a renal allograft. Tophaceous gout occurred in 10 patients (27%) and polyarticular involvement was seen in 16 (44%) at initial presentation. Five of nine premenopausal patients were taking cyclosporine and four had renal insufficiency. A comparison with a control group of 72 randomly selected male patients with gout showed that the female patients were frequently receiving diuretics at the time of the attack and had significantly lower mean uric acid excretion, whereas significantly more male patients showed heavy alcohol consumption and precipitating events for an acute attack compared with the female patients. There were no significant differences between the sexes for onset age, hypertension, renal insufficiency, distribution of joint involvement, tophi and mean serum uric acid concentration. The female patients in this study had a lower mean age at onset of gout than in previous studies, which was attributed to the inclusion of renal transplantation patients. Transplantation gout patients receiving cyclosporine lower the mean age at onset of female gout and this is an emerging problem in female gout.
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PMID:Clinical manifestations of Korean female gouty patients. 1079 27


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