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

In a 10-month prospective study a research assistant identified 411 patients with rheumatic disease at the 2 referral hospitals in Harare. Rheumatic disease accounted for less than 1% of hospital admissions. Rheumatoid arthritis, the commonest condition, accounted for 18% of patients, many of whom had impaired functional capacity. Septic arthritis (16%) was common in younger patients, often affecting the hip or knee and often associated with other complications of disseminated staphylococcal infection. Osteoarthritis (9%), rheumatic fever (7%), gout (6%), human immunodeficiency virus associated musculoskeletal problems (6%) and systemic lupus erythematosus (5%) were relatively common while the spondyloarthropathies occurred less frequently. The spectrum of rheumatic disease seen in teaching hospitals in Harare, although significantly different from that seen in Europe and North America, approximates the pattern seen in developed countries more closely than previous studies from Africa would suggest.
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PMID:A prospective analysis of patients with rheumatic diseases attending referral hospitals in Harare, Zimbabwe. 179 22

The differential diagnosis for metatarsalgia should include rheumatoid arthritis, SLE, mixed connective tissue disease, psoriatic arthritis, Reiter's syndrome, fibromyalgic syndrome, gout, post-traumatic joint disease, and septic arthritis. When the patient's symptoms are approached systematically an accurate diagnosis can lead to implementation of an appropriate treatment plan. Multidisciplinary treatment approaches often lead to the most satisfying therapeutic outcomes.
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PMID:Lesser metatarsalgia. Rheumatologic considerations. 225 74

Indium-111-labeled leukocyte scintigraphy was performed on a 66-yr-old male with polyarticular acute gouty arthritis. Images revealed intense labeled leukocyte accumulation in a pattern indistinguishable from septic arthritis, in both knees and ankles, and the metatarsophalangeal joint of both great toes, all of which were involved in the acute gouty attack. Joint aspirate as well as blood cultures were reported as no growth; the patient was treated with intravenous colchicine and ACTH for 10 days with dramatic improvement noted. Labeled leukocyte imaging, repeated 12 days after the initial study, revealed near total resolution of joint abnormalities, concordant with the patient's clinical improvement. This case demonstrates that while acute gouty arthritis is a potential pitfall in labeled leukocyte imaging, in the presence of known gout, it may provide a simple, objective, noninvasive method of evaluating patient response to therapy.
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PMID:Appearance of acute gouty arthritis on indium-111-labeled leukocyte scintigraphy. 234 5

A 73-year-old black man with chronic gout presented with a 1 1/2 year history of a swollen painful left wrist. Two draining ulcers over the ventral aspect of his wrist and radiographic changes of the affected area suggested chronic gouty arthritis, but culture of the fluid from the wrist grew Mycobacterium tuberculosis. This case extends the list of infectious agents producing septic arthritis in patients with gout to include Mycobacterium tuberculosis. The need for culture evaluation of joint fluid in patients with chronic as well as acute gout is emphasized.
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PMID:Tuberculous arthritis presenting as tophaceous gout. 250 26

A 62 year-old man had suffered from gout and mild renal insufficiency since he was 40 years old. He was admitted to our hospital complicated by a productive cough, high fever and a right swollen knee joint. The chest radiographs demonstrated a left upper lobe infiltration shadow. Streptococci pneumoniae were found in the sputum, arterial blood and synovial fluid of the right knee joint, suggesting a severe pneumonia followed by pneumococcal septicemia which led to purulent arthritis. He was treated with cefamandole (CMD) and penicillin G (PC-G) for one week, but the chest X-ray findings were not improved. After treatment with cefbuperazone (CBPZ) and latamoxef (LMOX), his fever and other symptoms gradually resolved. Streptococcus pneumoniae is an uncommon organism of septic arthritis. Pneumococcal arthritis in a patient without immunodeficiency such as this case is very rare, and has not been reported in Japan.
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PMID:[A case of pneumococcal arthritis in a patient with gout]. 261 92

The rheumatic manifestations of familial hypercholesterolemia include recurrent Achilles pain or tendinitis, acute mono/oligoarthritis and migratory (rheumatic fever-like) polyarthritis. Diagnosis is made by finding skin and tendon xanthomas, hypercholesterolemia, and ruling out other rheumatic conditions such as rheumatic fever, gout, pseudogout and septic arthritis. A patient, homozygous for familial hypercholesterolemia, with a rheumatic fever-like migratory arthritis is presented.
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PMID:Hypercholesterolemic (type II hyperlipoproteinemic) arthritis. 275 74

We recommend that physicians distinguish shoulder arthritis from periarticular disorders. A specific diagnosis should be made in the former, if possible. A number of arthritides have frequent shoulder involvement, and they should be kept in mind. Septic arthritis should always be suspected when there is acute pain and swelling. Joint fluid aspiration should almost always be performed when fluid is present. The diagnosis of gout or CPPD deposition disease usually requires crystal identification from joint fluid for diagnosis. Treatment of shoulder arthritis with oral anti-inflammatory medication is usually indicated; appropriate treatment of the underlying disorder, e.g., rheumatoid arthritis, is necessary. Physical therapy started early, often combined with IA corticosteroids, helps to maintain or improve shoulder motion.
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PMID:Causes and management of shoulder arthritis. 327 36

Two cases of coexisting septic and crystalline joint disease are reported. In one patient polyarticular septic arthritis occurred simultaneously with gout and pseudogout. In a second patient septic arthritis preceded the appearance of calcium pyrophosphate dihydrate (CPPD) crystals in the joint fluid, supporting an earlier postulate that lysosomal enzymes released during sepsis lead to shedding of crystals from cartilage and synovium into the joint space. This sequence was demonstrated in a rat air pouch model of synovium, in which CPPD crystals embedded in facsimile synovial tissue were released after injection of pyogenic bacteria. Coexisting septic arthritis should always be considered when crystals are identified in inflamed joints, particularly in elderly patients with concurrent infections.
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PMID:Crystal shedding in septic arthritis: case reports and in vivo evidence in an animal model. 346 9

The clinical and diagnostic features of 29 adult patients with H. influenzae septic arthritis are reviewed. Twelve men and 17 women ranging in age from 22 to 82 years developed the infection. H. influenzae septic arthritis is an acute, febrile disease with a mean duration of symptoms before diagnosis of 4 days. Fifteen patients had monoarticular arthritis, 6 with an infected knee. Polyarticular involvement, with a range of 2 to 9 joints, was diagnosed in 14 patients. Nineteen patients had concurrent extraarticular sites of infection, including meningitis, pneumonia, pharyngitis, sinusitis, conjunctivitis, and cellulitis. Twenty-two of 29 patients had predisposing factors for infection, including ethanolism, trauma, rheumatoid arthritis, systemic lupus erythematosus, diabetes mellitus, splenectomy, multiple myeloma, lymphoma, gout, and acquired common variable hypogammaglobulinemia. Characteristic synovial fluid findings included purulent, greenish fluid, elevated WBC count, and gram-negative pleomorphic microorganisms. Treatment for these patients included antibiotic therapy, most often ampicillin and chloramphenicol, and joint drainage by repeated arthrocentesis or arthrotomy. A favorable outcome was reported in 25 of 29 patients. Hemophilus influenzae septic arthritis should be suspected in adults who are immunocompromised and have a concurrent extraarticular source of infection.
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PMID:Hemophilus influenzae septic arthritis in adults. A report of four cases and a review of the literature. 348 37

Over a 12-month period, 150 patients were seen at an acute arthritis clinic to assess the type of case not usually seen in our chronic service, where delays of up to 24 weeks may occur before patients can be investigated. The majority of patients in whom the diagnosis could confidently be made had either gout or reactive arthritis, and, while the former diagnosis was unlikely to be missed, many practitioners seemed unaware of the type of presentation and variety of organisms that can cause reactive arthritis. Despite intensive investigation, a diagnosis could not be made in some cases. Those with septic arthritis had a better prognosis than patients in a previous series from this centre. Early referral leading to prompt diagnosis of this serious complication may have been an important factor in the improved outcome.
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PMID:An acute arthritis clinic--one year's experience. 373 Jul 38


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