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Between December 15, 1988 and November 30, 1990, the application of Rome and New York criteria enabled the diagnosis of 60 cases of gout among patients with arthritis or hyperuricemia seen as out-patients or hospitalised in the Department of Rheumatology of the Brazzavile T.H.G. There were 57 men and 3 women, with a mean age of 51. Gout is the primary form of inflammatory arthropathy in adults in the Congo. Affecting all socio-professional groups, it is diversely associated with obesity, alcoholism, hypertension and diabetes. Initial involvement affects the big toe. Oligo and polyarticular forms predominate because of the absence or delay in specific treatment. This series included 30 per cent of cases of chronic gout. Evidence of renal impairment was found in one third of patients. However, urate lithiasis was absent. Tophi were found preferentially over the elbows. Sickle cell disease was responsible for one case of tophaceous gout. In contrast with the results of studies undertaken before the 1980s, gout is seen to be a common condition in equatorial Africa.
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PMID:[Epidemiological and clinical aspects of gout in equatorial Africa. Apropos of 60 cases followed in the Department of Rheumatology of the Teaching Hospital Center in Brazzaville]. 178 Jun 67

Today hyperuricaemia and gout are likewise seen in every population of the western industrial world and have been increasing since the fifties. As known from number of studies hyperuricaemia often occurs in connection with hyperlipoproteinaemia, obesity, diabetes mellitus, arterial hypertension and atherosclerosis. Up to now it was not clear whether one disease caused the other. In 1988 Abbot could prove that among men, those afflicted by gout as compared to those without gout experienced a 60% excess of coronary heart disease. Therefore, patients with gout should receive a regular thorough cardiovascular evaluation. Furthermore risk factor levels which predispose to coronary heart disease, arterial hypertension and gout should be reduced. There is a significant positive correlation between the plasma uric acid levels and the prevalence of attacks of gouty arthritis and nephrolithiasis. It is possible to avoid gouty arthritis, tophi and nephrolithiasis with a consequent diet and medical treatment. Unfortunately, many patients interrupt therapy during intervals free of pain. The consequence is that even today the complications of hyperuricaemia cause days of inability to work and to earn one's living, despite of modern therapy. Hyperuricaemia not sufficiently treated reduces the quality of life through attacks of gout, chronic gout and nephrolithiasis as well as life expectancy caused by nephropathy, arterial hypertension and atherosclerosis. This is of special importance because of the frequency of gout and hyperuricaemia in our population. An early diagnosis, a consistent therapy and a thorough monitoring could stop an increase of this disease and prolong life expectancy for those who have gout and the other attendant diseases.
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PMID:[Hyperuricemia--does modern therapy improve life expectancy?]. 227 73

After longterm treatment (mean duration 7.2 years) with antihyperuricemic drugs, ten tophaceous gouty patients requested withdrawal of the medication because they had not felt any arthritic pains for years, the tophi had disappeared, and they disliked the idea of taking the medicine daily for the rest of their lives. Five patients (Group I) had no recurrence of either arthritis or tophi during follow-up for 18 to 52 months (average duration 33 months). Five patients (Group II) had a recurrence of arthritis 5 to 29 months (average 15.8 months) after cessation of therapy and two of them developed tophi again at 29 months and resumed treatment. Group II patients tended toward obesity, more severe hyperuricemia and an earlier age onset of gout, as compared with Group I patients. The creatinine concentration determined before, during, and after treatment showed no change. On the basis of the present findings it seems justified to withdraw medication in cases of tophaceous gout in remission when aggravating factors such as obesity and severe hyperuricemia are absent. Attacks of gout and tophi are likely to recur, but so far in our series the duration of the symptom-free period without medication is almost three years for Group I patients, who are now considered as "asymptomatic hyperuricemics".
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PMID:Withdrawal of longterm antihyperuricemic therapy in tophaceous gout. 358

An analysis of clinical symptoms and characteristic features of a course of gout in 10 women (3.4% of 290 gout patients) has shown that gout patients can represent a heterogeneous group in terms of age, predisposing causes (hereditary predisposition, change in a hormonal pattern, obesity and iatrogenic effects like the use of diuretics), concomitant pathology and variants of a disease course. Two clinical variants have been defined: classical in which disease develops during or after occurrence of menopause along a favorable course, without tophi and signs of chronic arthritis, and atypical which develops at a younger age, has a grave course and can rapidly progress (chronic polyarthritis with frequent recurrences can sometimes develop in the course of 2-3 yrs). No significant variations in the clinical picture were noted in comparison with those in men.
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PMID:[Gout in women]. 359 9

Development of ankylosis of joints involved with gouty arthritis is an exceedingly rare event of which only ten examples have been reported. Most patients had chronic, tophaceous gout that had not received adequate medical attention. The authors report two new cases including one in a patient with no documented history of acute gout. The first patient was a 72 year old noninsulin-dependent diabetic male who had been given a diagnosis of gouty polyarthritis with tophi seven years earlier. The second was a 42 year old male with no history of acute gout in whom hyperuricemia had been diagnosed at the age of 22 years upon evaluation for obesity. Both patients had ankylosis of the ankles and proximal interphalangeal joints of the hands. A marked decrease in range of motion of the wrists was found in the second patient. Roentgenograms showed complete ankylosis of the tarsus and partial ankylosis of the tibiotarsal joints in both patients, as well as ankylosis of the carpus in the second patient. The pathophysiology of ankylosis during gouty arthritis is poorly understood. A pannus containing abundant urate crystals is found upon pathological examination. Antihyperuricemic agents can reverse urate deposition but have no effect on ankylosis.
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PMID:[Ankylosing gout. Apropos of 2 cases]. 800 Apr 1

Characteristic feature of pathogenesis, epidemiology and laboratory findings in hyperuricemia of gouty patients are studied and reasonable treatments of gout in clinical medicine are discussed. Gout is characterized by repeated arthritis attacks on the metacarpophalangeal joint of the first toe or other small joints, especially overworked joints or those exposed to cold. The arthritis attack lasts for 3.5 days and then diminishes gradually. The intervals are shortened in patients under poor hyperuricemic control but tophi formation is less frequent. Complications in combination with hyperlipidemia, diabetes mellitus, obesity and hypertension, which are compatible to syndrome X, are frequent in gouty patients and are suspected of rapidly progressing to arteriosclerosis, such as ischemic heart diseases. Hyperuricemia consists of over-production and underexcretion, which can be diagnosed by the urate clearance test. Classification is valuable for surveying the underlying diseases of secondary hyperuricemia and treating gouty patients. Underexcretion was observed in 85% of gouty patients with hyperuricemia and even the mean urate clearance in the overproduction type was significantly lower than that of normal controls, suggesting that underexcretion is a fundamental phenomenon in all gouty patients. Treatments of complications as well as those of hyperuricemia with uricosuric agents are required for clinical treatment of gouty patients.
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PMID:[Characteristic features of gouty patients]. 897

The clinical features of 90 Black South African patients with gout seen at a large urban hospital were reviewed. The mean age of the patients was 54.3 and 55.3 years for men and women, respectively. The male:female ratio was 3.3:1. All except one of the women were postmenopausal. Seventy-nine percent of patients were from the lower income groups of "blue collar" workers, old-age pensioners or the unemployed. Polyarticular gout was observed in 44.4% of the patients. Tophi were noted in 51.1% of patients but none had a history of renal calculi. Risk factors were assessed by comparing the gouty patients to an equal number of age- and sex-matched hospital controls. Case-control analysis showed a "white collar" occupation (odds ratio = 7.4), obesity (odds ratio = 5.3), alcohol intake (odds ratio = 3.5) and hypertension (odds ratio = 3.3) to be significant risk factors for gout in the overall group of both men and women. In the subgroup of men only, obesity (odds ratio = 7.8), a "white collar" occupation (odds ratio = 6.4), hypertension (odds ratio = 4.9) and alcohol intake (odds ratio = 3.5) were similarly associated with gout. In women, a history of alcohol intake was the only significant risk factor associated with gout (odds ratio = 5.0). These findings suggest that in a population where gout was previously rare, changing dietary habits and lifestyle, together with improving socioeconomic conditions are contributing significantly to the increasing prevalence of the disease.
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PMID:Risk factors for gout: a hospital-based study in urban black South Africans. 959 90

Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or underexcretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels. Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids. Treatment goals include termination of the acute attack, prevention of recurrent attacks and prevention of complications associated with the deposition of urate crystals in tissues. Pharmacologic management remains the mainstay of treatment. Acute attacks may be terminated with the use of nonsteroidal anti-inflammatory agents, colchicine or intra-articular injections of corticosteroids. Probenecid, sulfinpyrazone and allopurinol can be used to prevent recurrent attacks. Obesity, alcohol intake and certain foods and medications can contribute to hyperuricemia. These potentially exacerbating factors should be identified and modified.
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PMID:Diagnosis and management of gout. 1060 85

Aim of this paper is to describe and discuss, on the basis of the available current literature, the case of a female patient affected by a tophaceous gout associated with plurimetabolic syndrome. Hyperuricemia and gout may be seen today in all the populations of developed countries, with increasing frequency on the last fifty years. Increased production or reduced urinary excretion of uric acid (and hypoxanthine and xanthine) are the most important pathogenetic mechanisms of primary or secondary hyperuricemia. Gout is an acute rheumatic disorder (characterized by a limited range of manifestations) which occurs in humans in connection with deposition of crystals of monosodium urate (the final product of purine metabolism) in the articular and soft periarticular tissues. Hyperuricemia and/or gout are often associated with hyperinsulinemia, obesity, diabetes mellitus, hyperlipemia, hypertension and atherosclerosis to form the syndrome called "Plurimetabolic syndrome" or "Syndrome X". Here we report the clinical case of a 64-year-old female patient who had android obesity, type 2 diabetes mellitus, hypertension, dyslipidemia and hyperuricemia and had been suffering (over many years) from intermittent episodes of severe pain and inflammatory joint swelling (first metacarpo- and metatarso-phalangeal joints) with development of pronounced multiple tophi in bone articular and soft periarticular tissues. Hyperuricemia and acute episodes had never been treated with anti-hyperuricemic drugs because gouty arthritis had never been diagnosed. This severe tophaceous gout associated to multiple metabolic disorders prompted us to present knowledge on gout and to focus on the interrelationships between hyperuricemia and/or gout and plurimetabolic syndrome, important risk factors for coronary heart disease.
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PMID:[Tophaceous gout in plurimetabolic syndrome]. 1021 66

Gouty arthritis, a common source of pain and disability, is the most common form of inflammatory arthritis affecting older people. The authors review the epidemiology and pathogenesis of hyperuricemia and gout, as well as the clinical forms of gouty arthritis. Gout is part of a clinical spectrum of conditions (obesity, diabetes mellitus, hyperlipidemia, coronary artery disease) and need for better patient education on management of these associated conditions is emphasized. The general algorithm of gout management is presented. Clinical particularities of gout presentation in older patients (increased incidence in women, polyarticular onset with hand involvement, earlier development of tophi, association with use of diuretics) are reviewed. Barriers against an optimal control of gout include lack of patient education, presence of comorbid conditions, particularly renal impairment, use of multiple drugs such as diuretics, and cognitive decline. Gout management in older adults remains unsatisfactory.
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PMID:Gouty arthritis. A primer on late-onset gout. 1602 79


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