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

Streptococcus iniae, a widely distributed fish pathogen, is known to cause rare cases of human infection. We describe 2 cases of invasive S. iniae infection, one with septic arthritis complicating chronic gout and the other with bacteremic cellulitis. Both patients were Chinese and have been regularly handling fresh fish for cooking. Both isolates were unidentified or misidentified by 3 commercially available identification system and were only identified by 16S rRNA gene sequencing. When compared with a clinical isolate of S. iniae from Canada, their colonies were larger, more beta-hemolytic, and microcoid. Although bacteremic cellulitis has been described as the most common infection associated with S. iniae, the bacterium has not been reported to cause exacerbations of gouty arthritis previously. Clinical laboratories should be aware of the possibility of different colony morphology of S. iniae from Asia. More accurate identification of nongroupable beta-hemolytic streptococci, especially from patients with epidemiologic linkage to fresh fish, may uncover more cases of S. iniae infection. The Asian population and handlers of fresh fish should be informed of the risk of acquiring S. iniae infection.
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PMID:Clinical isolates of Streptococcus iniae from Asia are more mucoid and beta-hemolytic than those from North America. 1642 43

Patients who visit the emergency department often have complaints of joint and limb pain. The differential diagnosis, clinical presentation, and treatment choices can be vastly different in the young- or middle-aged population compared with the elderly population, and the concerns of each group must be addressed. The emergency physician is in a unique position in that they are frequently the first to see these individuals and have the opportunity to intervene before permanent disability ensues. Some of the more common etiologies of atraumatic joint and limb pain, including crystal deposition diseases such as gout and pseudogout, osteoarthritis, septic arthritis, and inflammatory arthritides such as rheumatoid arthritis will be addressed in this article. In addition,several arthritides specific to the elderly population such as poly-myalgia rheumatica and associated giant cell arteritis will be covered. Finally a discussion of cervical and lumbar disc disease, as well as gait disorders, and their impact on the elderly, will be presented.
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PMID:Atraumatic joint and limb pain in the elderly. 1658 63

The objective of this study was to determine the incidence of septic arthritis in the presence of joint crystals. A retrospective study was conducted at a university tertiary care referral center. The study population included all patients with synovial fluid crystals in the joint aspirate sent to the laboratory during the 7-year study period. Septic arthritis was defined as a positive synovial culture. Of the 265 joint aspirates containing crystals, 183 (69.0%) contained gout crystals, 81 (30.6%) contained pseudogout crystals, and 1 (0.4%) contained both. Four (1.5%) of the aspirates had positive cultures. The mean synovial WBC of the 4 samples with concomitant crystals and septic arthritis was 113,000 (95% confidence interval [CI] 72,700-153,200), which was significantly higher than the entire population at 23,200 (95% CI 19,400-27,000; p < 0.01). Of note, all 4 patients with concomitant disease had significant co-morbidities and synovial WBC counts greater than 50,000. Septic arthritis and acute crystal-induced arthritis can occur simultaneously; there were 4 cases (1.5%) of concomitant disease in our study population. The presence of crystals cannot exclude septic arthritis with certainty.
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PMID:Does the presence of crystal arthritis rule out septic arthritis? 1723 29

The authors report 100 cases of knee septic arthritis seen during ten years among 2298 patients admitted in the rheumatology department of Brazzaville university teaching hospital. Bone and joint infection is the first hospitalisation cause in this service. Knee is the first septic localization with 42% of cases coming before hip 25%, sacro-iliac 18% and shoulder 7%. Patients are 56 males and 44 females aged from 5 to 79 years old, average 35 years. Most frequently germs are Staphylococcus aureus in half cases, Mycobacterium tuberculosis in 30% of cases and gram-negative bacillus. Contributing factors are AIDS: 12 cases, diabetes mellitus: 7 cases, alcohol-tobacco intoxications: 4 cases, ickle-cell disease: 3 cases, gout and renal failure in 2 cases each. Late diagnosis and consultation, inadapted antibiotic drugs are responsible for important articular damages compromising further functional prognosis.
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PMID:[Knee septic arthritis: 100 cases report in intertropical zone]. 1730 42

Common causes of acute monarthritis are osteoarthritis, an acute attack of gout or other crystal arthropathies in older patients or a reactive arthritis or gonococcal arthritis in younger patients. The differential diagnosis should primarily rule out septic arthritis. An arthrocentesis with a microbiological work up and a fresh specimen should be prepared for the diagnosis of crystal arthropathies and if an infectious origin is suspected or if nothing remarkable was found during the primary examination. Further diagnosis und therapy should be performed by a specialist.
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PMID:[Acute monarthritis]. 1807 70

Neuropathic arthropathies is a destructive and deforming joint process related to a disruption of propioceptive and nocioceptive innervation. Growth factors, neurological and vascular factors might be involved. Diabetes, alcoholic neuropathy or syringomyelia appear as the most common causes. We report the case of a 61-year-old woman affected by syringomyelia, with a neuropathic arthropathy of the shoulder. Differential diagnosis includes neurological diseases, septic arthritis, tumours and other destructive arthropathies such as aseptic nechrosis, chronic osteomyelitis, synovial chondromatosis, metabolic diseases (gout, chondrocalcinosis) or repetitive haemarthrosis in haemophilia.
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PMID:[Neuropathic arthropathy of the shoulder]. 1822 3

This article describes a 69-year-old man with a bilateral total knee prosthesis in whom both knees were swollen and painful. Fever was present and the levels of inflammation markers were markedly elevated. Gout was diagnosed in the right knee and haemarthros during calcium carbasalate use in the left knee. Gout in a knee with a total knee prosthesis is rare and can mimic septic arthritis. Early diagnosis is of particular importance as the therapy of the two conditions differs considerably. Gout is treated with medication while surgical treatment is necessary in a case of septic arthritis, which may even involve removal of the prosthesis.
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PMID:[Gouty arthritis in a total knee prosthesis]. 1855 68

Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses: (1) the indications, the technical principles and the expected benefits and risks of aspiration and injection of intra-articular corticosteroid; and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration, although any non-axial joint is accessible for obtaining SF. The technique requires a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing joint inflammation is associated with increased SF volume, reduced viscosity, increasing turbidity and cell count, and increasing ratio of polymorphonuclear: mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis.
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PMID:Joint aspiration and injection and synovial fluid analysis. 1939 65

Mycobacterium kansasii septic arthritis is rare, most often occurring in immunosuppressed patients including those with organ transplants. We present a case of oligoarticular M. kansasii infection in bilateral ankles, knee, and bilateral olecranon bursae in coexistence with tophaceous gouty arthropathy in a heart transplant patient. There are no reports of M. kansasii infection occurring in joints also affected by tophaceous gout. We contend that gouty arthropathy may alter the joint in such a way as to increase the risk of development of this infection in patients already at risk. In transplant patients presenting with a history and pattern of arthritis consistent with gout, a sufficient level of suspicion should be maintained for this infectious complication, even if monosodium urate crystals are seen on joint aspiration.
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PMID:Coexistence of oligo-articular gout and Mycobacterium kansasii joint and bursal infection in a patient with an orthotopic heart transplant. 1991 72

There are many potential causes of joint pain in older patients. The most likely aetiology is OA. However, the differential diagnosis includes conditions which should not be missed such as septic arthritis and inflammatory disease. The pattern of joint involvement points to the diagnosis. Bilateral symmetrical small joint pain, swelling and stiffness should arouse the suspicion of RA. The wrist and knee are commonly affected by pseudogout and the first metatarsophalangeal joint or knee joint involvement may represent gout. Stiffness in the shoulder and hip girdles, worse in the morning, suggests polymyalgia rheumatica. In straightforward cases of OA no specific investigations are required. If doubt exists, however, tests may be necessary including FBC, ESR and CRP, uric acid for suspected gout and X-rays of the affected joints especially following trauma, or pseudogout. Patients with OA should be offered education and advice as well as strengthening exercises and aerobic fitness training (if physically possible). If the patient is overweight, weight loss is critical, especially in OA of the knee. Paracetamol and topical NSAIDs are the first-line drug treatments. Elderly onset RA differs from younger onset RA in the following ways: a more balanced gender distribution; a higher frequency of acute onset; an association with systemic features; more frequent involvement of the shoulder girdle and higher disease activity. DMARD therapy should be used according to disease severity, as in younger onset RA. The current approach is for early, intensive intervention with combination therapy. Corticosteroids may be very effective in the elderly, however, prolonged use and/or high dosage may lead to marked toxicity especially osteoporosis and diabetes.
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PMID:Diagnosing joint pain in the older people. 2019 31


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