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

Two cases of coexistent gout and septic arthritis are presented. The known increased incidence of joint injections in patients with rheumatoid arthritis is contrasted with the relative rarity of this complication in persons with gouty arthritis. The reason for this dichotomy is not clear but it is suggested that an important factor may be the more episodic nature of the gouty process. For patients presenting with acute arthritis the possible concurrence of sepsis and gout should be considered.
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PMID:Coexistent gout and septic arthritis: a report of two cases and literature review. 390 98

The identification of monosodium urate crystals in joint effusions of patients with gouty arthritis established that crystals can cause arthritis. Other crystals causing arthritis have also been identified, including calcium, pyrophosphate dihydrate (chondrocalcinosis, pseudo-gout), calcium hydroxapatite crystals (calcific periarthritis, acute arthritis) and depot corticosteroid crystals (which occasionally cause arthritis when injected intra-articularly.) Crystal-induced arthritis is characterized by acute articular inflammation although rarely causing joint destruction or permanent disability. It is important for clinicians because it can mimic more serious joint diseases like septic arthritis or even rheumatoid arthritis. It can be diagnosed with precision and in some types as in gout can be treated effectively. Also, it constitutes one of the best understood articular inflammatory processes and often is the first clinical clue for the presence of curable metabolic or endocrine diseases.
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PMID:Crystal-induced arthritis. 628 63

Although peripheral metastases of many malignancies to bone are common, metastases to the hand and carpus are rare. This is the first report of a silent primary malignancy of the lung presenting as a metastasis to the carpal navicular bone. Only eight instances of carpal bone metastases secondary to all tumor sources were revealed in a search of the literature. The presentation of metastatic disease in the hand in an occult malignancy may be deceptive, often mimicking pulp space infection, osteomyelitis, septic arthritis, gout, acute rheumatoid monoarticular arthritis, tenosynovitis, or sympathetic dystrophy. These lesions often present as radiolucent lesions; histologic findings are consistent with the tumor of origin. Treatment is palliative and consists of resection or amputation. Radiotherapy should be avoided in the hand due to secondary fibrosis and scarring.
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PMID:Presentation of malignancy by metastasis to the carpal navicular bone. 646 20

Rheumatic pain is usually generalized, but in a variety of conditions it may present as localized and often remain so. These conditions include palindromic rheumatism, osteoarthritis, gout or pseudogout, seronegative spondyloarthropathy, septic arthritis, tendinitis and bursitis, radiculopathy and nerve entrapment, nodular growth, and tendon enlargement. When the presenting feature is focal pain in muscles, joints, or fibrous tissue, the differential diagnosis should include these considerations.
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PMID:Localized rheumatologic diseases. Common diagnostic challenges. 660 May 15

This study applied threshold analysis and likelihood ratios to determine the usefulness of a diagnostic test. Eleven staff rheumatologists or rheumatology fellows provided probability estimates for the most likely diagnoses both before and after synovial fluid analyses were performed on 180 patients with joint effusions. They also indicated whether the planned therapy was altered by the test results. The therapeutic thresholds and log likelihood ratios were derived for the six most frequent diagnoses. Synovial fluid analysis was most useful for patients likely to have gout, pseudogout, or infectious arthritis. The derived therapeutic thresholds were consistent with recommended medical practice, for example, with a lower threshold for possible septic arthritis (20%) than for possible gout (65%). This study demonstrates that threshold analysis and likelihood ratios can be used to assess the clinical contribution of diagnostic tests.
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PMID:Usefulness of synovial fluid analysis in the evaluation of joint effusions. Use of threshold analysis and likelihood ratios to assess a diagnostic test. 671 68

We report here on 41 male patients with acute polyarticular gout seen in 3 years. Acute polyarticular gout continues to masquerade as other commoner rheumatological disorders such as septic arthritis, rheumatoid arthritis, degenerative joint disease, and even hemiparesis. Almost all of these patients had clues to the diagnosis of acute gout in their medical history. These clues included a past history of intermittent acute gout, prior attacks of polyarticular arthritis, previous hyperuricaemia, and/or obvious tophi. The patients all responded promptly to nonsteroidal anti-inflammatory drugs. We observed serious toxic drug reactions in 8 patients.
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PMID:Acute polyarticular gout. 684 58

Lactic acid concentrations in the synovial fluid of 71 patients with inflammatory arthritis were determined by an enzyme method. In 63 samples from 54 patients with a variety of non-septic arthritides, including rheumatoid arthritis, reactive arthritis and gout, the concentration of lactic acid was never greater than 10.2 mmol/l, whereas all twelve patients with septic arthritis had concentrations of 11 mmol/l or greater. Two patients with gonococcal arthritis did not have raised lactic acid concentrations. The enzyme method of lactic acid estimation is an accurate reproducible means of differentiating septic from nonseptic arthritis prior to the isolation of the infecting organism. However, caution is necessary when interpreting the results in those patients who have recently received antibiotic therapy, or in whom gonococcal arthritis is suspected.
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PMID:Synovial fluid lactic acid in septic arthritis. 694 53

Chondrocalcinosis is an arthropathy caused by deposits of calcium pyrophosphate-dihydrate microcrystals (CPPD) in the joints and occasionally in the tendons and ligaments. In our region it is almost always seen in its sporadic form in elderly subjects. The patients can be without symptoms or present four different clinical entities: an acute arthritis which can resemble and even be mistaken for an attack of gout or a septic arthritis; an inflammatory polyarthritis suggesting a rheumatoid arthritis; most frequently it appears as a benign polyarthrosis; sometimes it runs a destructive course capable of seriously damaging one or several joints. In certain cases chondrocalcinosis is associated with another metabolic disease. Familial forms have been described in some countries. Factors which induce the formation of the deposits of CPPD in the articular cartilages, fibrocartilages, the synovium and occasionally in the tendons and ligaments remain obscure. In contrast to urate gout, chondrocalcinosis appears to be due to a disturbance of pyrophosphate metabolism localized almost exclusively in the articular region. Its association with polyarthrosis rather frequently leads to destructive arthropathies. No etiological treatment for chondrocalcinosis exists at the present time. Therapy is limited to the administration of nonsteroidal antiinflammatory drugs and physiotherapy.
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PMID:[Chondrocalcinosis]. 711 58

The simultaneous occurrence of septic arthritis and gout is quite uncommon. We describe a patient with chronic gout who developed pneumococcal pneumonia. Twenty-four hours later, his previously involved joints became acutely inflamed and were found to contain both pneumococcal organisms and monosodium urate crystals intracellularly. The mechanisms which may confer upon a gouty joint selective resistance or susceptibility to colonization by a blood borne organism are discussed. Septic arthritis must remain a consideration in patients with chronic gouty arthritis.
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PMID:Pneumococcal arthritis complicating gout. Case report and literature review. 720 31

329 synovial fluids from various joint diseases were examined. 95% of the fluids from arthrosis contained less than 1 000 cells/ml, figure which seemed to us to be the limit which separates arthrosis from arthritis. Above 100.000 cells/ml, the diagnosis is always pyogenic arthritis. Between 50.000 and 100.000 cells/ml, one may find pyogenic arthritis but also a few cases of rheumatoid arthritis, psoriatic rheumatism, gout and pseudo-gout. In chondrocalcinosis, the fluid variable, often poor in cells. The percentage of polymorphs is of little diagnostic interest; it exceeds 50% in all cases of pyogenic arthritis. R.A. cells are almost constant in fluids with more than 1 000 cells/ml and their diagnostic interest is not great.
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PMID:[Results of the cytological examination of the synovial fluid in various arthropathies]. 722 54


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