Gout: A Rapid Review of Presentation, Diagnosis and Management.

Gout is inflammatory arthritis caused by monosodium urate crystal deposition in articular and non-articular structures. Acute gout flares are often monoarticular/polyarticular involving lower extremity joints characteristically involving 1st metatarsophalangeal joint. However, gout flares can also be polyarticular, involving upper extremity joints, especially in patients with multiple comorbidities and contraindications to urate-lowering therapies (ULT). Risk factors exacerbating gout flares include obesity, high alcohol and purine-rich food consumption, and the use of diuretics. Diagnosis requires synovial fluid analysis with direct visualization of monosodium urate crystals. Acute flares are managed with steroids, non-steroidal anti-inflammatory drugs, or colchicine. Long-term management includes lifestyle modifications including a heavy emphasis on weight loss, avoidance of alcohol, purine-rich foods, and diuretics. ULT is indicated in patients with 2 or more gout flares/year, tophi, or radiographic evidence of gouty arthropathy. Although allopurinol is the first-line ULT agent, it does carry a risk of inducing severe cutaneous adverse reactions, especially in patients with chronic kidney disease and patients harboring the HLA-B*5801 allele. Other ULT agents include febuxostat and probenecid. ULT is usually titrated to achieve goal serum uric acid (SUA) levels below 6 mg/dL. However, in patients with tophi, a lower SUA target of less than 5 mg/dL should be implemented for prompt urate crystal dissolution.

The effect of exercise rehabilitation with exergames combined with ice therapy in the treatment of obese patients with gout: protocol for a clinical trial.

BACKGROUND: Gout remains a leading cause of inflammatory arthritis worldwide, and the main risk factor for gout is persistent hyperuricemia. The clinical management of gout is mostly drug-based, and other treatment options are often ignored. This research proposal will explore whether exergames combined with ice therapy can help patients with gout to lose weight, relieve pain, improve the range of movement, improve quality of life, decrease uric acid level, decrease kinesiophobia and improve mental health of patients with gout. METHODS: This experiment will use a two-arm randomized controlled design. The study setting is at the Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia (USM). Obese patients with gout (N = 30) will be randomly assigned to the control group (receive an exergames intervention) and intervention group (receive an exergames intervention combined with ice therapy). The outcomes measurement will be conducted before (baseline) and after intervention (4 weeks). Then, it will be followed up at 12 weeks. DISCUSSION: To our knowledge, no study has investigated the effect of exergames and ice therapy among gout patients. This study is expected to demonstrate that exercise rehabilitation facilitated by exergames with ice therapy is more effective in gout management compared to a conventional rehabilitation intervention. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2300070029). Registered on 31 March 2023.

Mild hyperthermia enhanced synergistic uric acid degradation and multiple ROS elimination for an effective acute gout therapy.

BACKGROUND: Acute gouty is caused by the excessive accumulation of Monosodium Urate (MSU) crystals within various parts of the body, which leads to a deterioration of the local microenvironment. This degradation is marked by elevated levels of uric acid (UA), increased reactive oxygen species (ROS) production, hypoxic conditions, an upsurge in pro-inflammatory mediators, and mitochondrial dysfunction. RESULTS: In this study, we developed a multifunctional nanoparticle of polydopamine-platinum (PDA@Pt) to combat acute gout by leveraging mild hyperthermia to synergistically enhance UA degradation and anti-inflammatory effect. Herein, PDA acts as a foundational template that facilitates the growth of a Pt shell on the surface of its nanospheres, leading to the formation of the PDA@Pt nanomedicine. Within this therapeutic agent, the Pt nanoparticle catalyzes the decomposition of UA and actively breaks down endogenous hydrogen peroxide (H2O2) to produce O2, which helps to alleviate hypoxic conditions. Concurrently, the PDA component possesses exceptional capacity for ROS scavenging. Most significantly, Both PDA and Pt shell exhibit absorption in the Near-Infrared-II (NIR-II) region, which not only endow PDA@Pt with superior photothermal conversion efficiency for effective photothermal therapy (PTT) but also substantially enhances the nanomedicine's capacity for UA degradation, O2 production and ROS scavenging enzymatic activities. This photothermally-enhanced approach effectively facilitates the repair of mitochondrial damage and downregulates the NF-κB signaling pathway to inhibit the expression of pro-inflammatory cytokines. CONCLUSIONS: The multifunctional nanomedicine PDA@Pt exhibits exceptional efficacy in UA reduction and anti-inflammatory effects, presenting a promising potential therapeutic strategy for the management of acute gout.

Gout and its management.

Gout is a common and treatable chronic disease of monosodium urate crystal deposition. It is experienced as extremely painful episodes of joint inflammation that impact all aspects of the person's life. This Clinical Perspectives article provides an update on gout diagnosis, medications and strategies to improve the quality of gout care.

The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial.

Background: In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues. Objective: This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels. Methods: This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention. Results: Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50%) and control (n=60, 50%) groups. Of the 120 participants, 93 (77.5%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time (ß=0.617, 95% CI 0.104-1.129; P=.02 and ß=1.300, 95% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week (ß=1.667, 95% CI -3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week (ß=6.287, 95% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43). Conclusions: Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout.

[Gout, beyond the joint: How should we treat it?] / La gota, más allá de la articulación: ¿cómo debemos tratarla?

Gout is a disease caused by the chronic deposition of monosodium urate crystals. Its clinical presentation as an acute, self-limiting arthritis and the belief that it is a banal, self-inflicted disease have led to its poor management. Despite advances in the knowledge of the disease and the simplicity of its management, no more than 30% of patients are well treated. In Spain, the prevalence of gout is 2.5% and its incidence is increasing. In the following article we will review the pathogenesis of gout and hyperuricaemia, highlighting the greater weight of genetics and renal function over diet. We will look at the consequences of crystal deposition. Gout, in addition to its joint presentation and renal involvement, has been shown to be an independent cardiovascular risk factor. Hypouricemic therapy is the most important treatment, as it is the one that dissolves the crystals and cures the disease. This requires the sustained achievement of uricemia levels below 6mg/dl. We will also review preventive and flares treatment, as well as the role of patient education in terms of both lifestyle and dietary habits and adherence to pharmacological treatment.

Gout in Native Hawaiian Patients in Hawai'i: Clinical Characteristics and Disparities.

OBJECTIVE: The purpose of this study was to investigate differences in clinical characteristics and health care use of Native Hawaiian and White patients with gout. METHODS: We performed a retrospective chart review of Native Hawaiian and White patients with gout treated from 2011 to 2017 within a large health care system in Hawai'i. We compared demographic characteristics, clinical outcomes, and risk factors for gout. We used multivariable logistic regression to identify predictive factors of emergency department visits. RESULTS: We identified 270 Native Hawaiian patients with gout and 239 White patients with gout. The Native Hawaiian patients were younger on average (54.0 vs 64.0 years; P < 0.0001) and had an earlier onset of disease (50.0 vs 57.0 years; P < 0.0001). Native Hawaiian patients with gout had higher mean (7.58 vs 6.87 mg/dL; P < 0.0001) and maximum (10.30 vs 9.50 mg/dL; P < 0.0001) serum urate levels compared to White patients with gout. Native Hawaiian patients with gout also had a greater number of tophi (median 2.00 vs 1.00; P < 0.0001). Native Hawaiians patients with gout were 2.7 times more likely to have frequent (≥1) emergency department visits than White patients with gout. Native Hawaiian patients with gout were less likely to have a therapeutic serum urate ≤6.0 mg/dL and had lower rates of rheumatology specialty care. CONCLUSION: Native Hawaiian patients have a higher disease burden of gout, with earlier disease onset and more tophi. Native Hawaiian patients with gout are more likely to use emergency services for gout and have lower rates of rheumatology specialty care compared to White patients. Future studies are needed to promote culturally appropriate preventive care and management of gout in Native Hawaiians.

Lycopodium as a treatment for Urate Deposition (gout) in birds: case report

A 3-year-old male cockatiel (Nymphicus hollandicus) was diagnosed with joint arthritis due to hyperucemiasyndrome. The bird presented deposition of urate crystals on the synovial membrane with inflammation of joints and tendons (tufts), causing listlessness, anorexia and lameness, with difficulty in keeping perched or moving. Laboratory tests displayed an increase in uric acid and creatinine phosphokinase levels, and leukocytosis despite lymphopenia. Unsucessfully, the animal had been treated with allopathic medicine for 2 months, without a favorable response and still developing stressful reaction to handling.Methodology:High dilution therapy was attempted with 2 globules of Lycopodiumclavatum30 cH /bid and Arnica montana30 cH /bid /oral. The most expressive tufts were removed with daily cleaning of the affected area; a new diet was established and perches were removed, allowing the bird to remain on a flat surface until regression of symptoms. The medication was continued for 30 days. On the second appointment, although the caregiver reported episodes of probable pain, there was an improvement in behavior with normal appetite. Lyc30cH /sid was continued and Arn30cH /bid to qid, depending on pain episodes, for over 30 days. The tutor authorized the case report through a consent form. Results and discussion:Follow-up laboratory tests were performed everythree months for one year, reaching normal levels for uric acid (3.5-11 mg/dL) and CK (30-245mg/dL) on the third measurement. The bird presented no formation of new tufts along the second month of treatment. After 12 months, the animal ingests homeopathic globules spontaneously and presents stable clinical presentation (Lyc30cH / sid / 3 times a week) with no recurrence and without side effects nor stressful behavior. Conclusion: In view of these results, it is considered that homeopathic treatment is an option to be considered in the treatment of joint arthritis from hyperuricemia syndrome in birds.

Tratamento da Gota na Atenção Primária à Saúde / Treatment of Gout in the Primary Health Care / Tratamiento de la Gota en la Atención Primaria de la Salud

Objetivo: O objetivo desta revisão é fornecer informação atualizada e orientações práticas sobre a abordagem da gota na Atenção Primária à Saúde. Métodos: Foram pesquisadas normas de orientação clínica, revisões sistemáticas, meta-análises e estudos originais publicados entre 1 janeiro de 2011 e 31 dezembro de 2016, nas línguas inglesa, portuguesa e espanhola. Resultados: Os fármacos de primeira linha no tratamento da gota aguda são os anti-inflamatórios não esteroides, a colchicina e os corticoides, em monoterapia ou associação. Na gota crônica são usados hipouricemiantes, sendo a primeira linha o alopurinol. O febuxostate e os uricosúricos são alternativas ao alopurinol em casos de intolerância ou ineficácia. A profilaxia das crises de gota agudas está recomendada quando se inicia o tratamento hipouricemiante durante pelo menos 6 meses. Conclusão: A abordagem correta da gota deve fazer parte das competências de um médico especialista em Atenção Primária à Saúde de modo a prestar cuidados adequados à comunidade.

Objective: The objective of this review is to provide updated information and practical guidelines on the approach of gout in Primary Health Care. Methods: We conducted a survey of clinical guidelines, systematic reviews, meta-analyses and original studies published between January 1, 2011 and December 31, 2016 in the English, Portuguese and Spanish languages. Results: First-line drugs in the treatment of acute gout are non-steroidal anti-inflammatory drugs, colchicine and corticosteroids, in monotherapy or combination. In chronic gout, the first-line of hypouricemic therapy is allopurinol. Febuxostat and uricosurics are alternatives to allopurinol in cases of intolerance or ineffectiveness. The prophylaxis of acute attacks is recommended when starting hypouricemic treatment for at least 6 months. Treatment of asymptomatic hyperuricemia is not recommended. Conclusion: The correct approach to gout should be part of the skills of a Primary Care physician in order to provide adequate care to the community.

Objetivo: El objetivo es proporcionar información actualizada y orientación práctica sobre la terapéutica de la gota en la Atención Primaria de Salud. Métodos: Se estudiaron las guías clínicas, revisiones sistemáticas, meta-análisis y estudios originales publicados entre el 1 de enero de 2011 y el 31 de diciembre de 2016, en el inglés, portugués y español. Resultados: Los fármacos de primera línea en el tratamiento de la gota aguda son anti-inflamatorios no-esteroides, la colchicina y los corticosteroides, solos o en combinación. En la gota crónica son utilizados hipouricemiantes, y el alopurinol es lo fármaco de primera línea. Febuxostat y uricosúricos son alternativas al alopurinol en los casos de intolerancia o ineficacia. Se recomienda la profilaxis de las crisis agudas en el tratamiento hipouricemiante durante al menos 6 meses. No se recomienda el tratamiento de la hiperuricemia asintomática. Conclusión: La terapéutica de la gota debe formar parte de las competencias de un médico especialista en Atención Primaria de Salud a fin de proporcionar la atención adecuada a la comunidad.

Relevant aspects of imaging in the diagnosis and management of gout / Aspectos relevantes do diagnóstico e seguimento por imagem na gota

ABSTRACT Gout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population aging.In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for monosodium urate crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis. In these situations, imaging methods have a fundamental role, aiding in the diagnostic confirmation or excluding other possible differential diagnosis. Conventional radiographs are still the most commonly used method in gout patients’ evaluation; nevertheless, this is not a sensitive method, since it detect only late alterations. In the last years, there have been several advances in imaging methods for gout patients. Ultrasound has shown a great accuracy in the diagnosis of gout, identifying monosodium urate deposits in the synovial membrane and articular cartilage, in detecting and characterizing tophi and in identifying tophaceous tendinopathy and enthesopathy. Ultrasound has also been able to show crystal deposition in patients with articular pain in the absence of a classical gout crisis. Computed tomography is an excellent method for detecting bone erosions, being useful in spine involvement. Dual-energy CT is a new method able to provide information about the chemical composition of tissues, with high accuracy in the identification of monosodium urate deposits, even in the early stages of the disease and in cases of difficult characterization. Magnetic resonance imaging is useful in the evaluation of deep tissues not accessible by ultrasound. Besides the diagnosis, with the emergence of new drugs that aim to reduce tophaceous burden, imaging methods have become useful tools in monitoring the treatment of patients with gout.

RESUMO A gota é uma artrite caracterizada pela deposição de cristais de monourato sódico na membrana sinovial, na cartilagem articular e nos tecidos periarticulares que leva a um processo inflamatório. Na maioria dos casos o diagnóstico é estabelecido por critérios clínicos e pela análise do líquido sinovial, em busca dos cristais de MSU. Porém, a gota pode se manifestar de maneiras atípicas e dificultar o diagnóstico. Nessas situações, os exames de imagem têm papel fundamental, auxiliam na confirmação diagnóstica ou ainda excluem outros diagnósticos diferenciais. A radiografia convencional ainda é o método mais usado no acompanhamento desses pacientes, porém é um exame pouco sensível, por detectar somente alterações tardias. Nos últimos anos, surgiram avanços nos métodos de imagem em relação à gota. O ultrassom se mostra um exame de grande acurácia no diagnóstico de gota, identifica depósitos de MSU na cartilagem articular e nos tecidos periarticulares e detecta e caracteriza tofos, tendinopatias e entesopatias por tofos. A tomografia computadorizada é um ótimo exame para a detecção de erosões ósseas e avaliação do acometimento na coluna. A tomografia computadorizada de dupla-energia, um método novo, fornece informações sobre a composição química dos tecidos, permite a identificação dos depósitos de MSU com elevada acurácia. A ressonância magnética pode ser útil na avalição dos tecidos profundos, não acessíveis ao ultrassom. Além do diagnóstico, com o surgimento de drogas que visam reduzir a carga tofácea, os exames de imagem se tornam uma ferramenta útil no acompanhamento do tratamento dos pacientes com gota.

Validación del método espectrofotométrico para control de calidad de la colchicina en Artrichine tabletas / Validation of the spectrophotometric method for the quality control of Artrichine tablets

Introducción: la colchicina es una alternativa terapéutica indicada por vía oral para las crisis agudas de la gota. Se formula en tabletas de baja dosificación debido a su elevada toxicidad. Los Laboratorios Dr.A. Bjarner C.A producen las tabletas de Artrichine y se requiere de un método sencillo, pero a la vez confiable para realizar el control de calidad de este producto terminado, que considere la solubilidad en etanol, la presencia de cromóforos y la composición de la formulación de la colchicina. Objetivo: se propuso validar un método por espectrofotomería UV útil para el control de rutina. Métodos: se aplicó un método simple, que se modifica del método establecido en la Farmacopea Británica del 2009 para las tabletas, por espectrofotometría UV directa. Se basa en la extracción del analito en etanol absoluto y su posterior determinación a 350 nm. La validación del método se realizó a través de los parámetros linealidad, precisión, exactitud y especificidad frente a los componentes de la formulación. Resultados: se estableció una metodología analítica muy sencilla para obtener una solución transparente a partir de la forma terminada, de igual concentración a la solución de referencia. El cumplimiento satisfactorio de todos los criterios de aceptación establecidos para los parámetros evaluados permitió demostrar la validez del método en estudio para el control de calidad en el rango de 50 a 150 por ciento (5-15 µg/mL). Conclusiones: el método por espectrofotometría UV resultó específico, lineal, exacto y preciso para su aplicación al control de calidad de la colchicina en Artrichine tabletas(AU)

Introduction: colchicine is a therapeutic alternative orally prescribed for acute gout. It is formulated as low dose tables due to its high toxicity. Dr A. Bjarner C.A laboratories manufacture Artrichine tablets and it requires a simple and reliable method to conduct quality control of the finished product that will consider ethanol-soluble characteristics, presence of chromophores and composition of colchicine formulation. Objective: to validate an ultraviolet spectrophotometry-based method for the routine quality control. Methods: a simple method by direct UV spectrophotometry which is modified from the set method of the British Pharmacopeia 2009 for tablets. It is based on the analyte extraction in absolute ethanol and the estimation at 350 nm. The method was validated on account of linearity, precision, accuracy and specificity against the formulation components. Results: a very simple analytical methodology was established to obtain a transparent solution from the finished form, with the same concentration as that of the reference solution. The satisfactory compliance with all the acceptance criteria for the evaluated parameters allowed proving the validity of the study method for the quality control in the 50 to 150 percent range (5-15 ug/ml). Conclusions: the UV spectrophotometry-based method proved to be specific, linear, accurate and precise for the quality control of colchicine in Artrichine tablets(AU)

Gota axial / Gout in the spine

A gota axial pode afetar todos os segmentos da coluna vertebral. Ela se manifesta como dor nas costas, dor associada com sintomas neurológicos, e como comprometimento neurológico sem dor em 17,9%, 75,8% e 4,2% dos casos, respectivamente. Essas manifestações foram a primeira apresentação da gota em muitos pacientes. Embora radiografias, bem como tomografia computadorizada e especialmente ressonância magnética, possam ser muito sugestivos, análises histopatológicas, citológicas e pesquisa de cristais são o padrão ouro de diagnóstico. Na maioria dos casos que envolveram manifestações neurológicas, o paciente foi submetido à cirurgia, levando a resultados satisfatórios. Há, no entanto, alguns relatos de recuperação total após o tratamento clínico habitual para gota, o que sugere que esse tratamento pode ser a opção inicial para os indivíduos com histórico de gota e sinais radiológicos de envolvimento axial.

Axial gout can affect all segments of the spine. It is manifested as back pain, as pain associated with neurological symptoms, and as neurological impairment without pain in 17.9%, 75.8% and 4.2% of cases, respectively. These manifestations were the first presentation of gout in many patients. Although x-rays as well as computed tomography and especially magnetic resonance scans can be very suggestive, histopathological, cytological and crystal analyses are the diagnostic gold standard. In most cases involving neurological manifestations, the patient underwent surgery, leading to satisfactory results. There are, however, some reports of full recovery following the usual clinical treatment for gout, suggesting that such treatment may be the initial option for those subjects with a history of gout and radiological findings of axial involvement.

Diagnóstico da monoartrite aguda na emergência / Diagnosis of acute monoarthritis in emergency

JUSTIFICATIVA E OBJETIVOS: A apresentação clínica B de artrite aguda na emergência é frequente e seu diagnóstico, etiológico é desafiador, tendo uma gama de possíveis diagnósticos. A correta avaliação da causa precipitante do sintoma é de extrema importância para orientar o tratamento adequado, minimizando as complicações. O objetivo deste estudo foi auxiliar o médico emergencista, no atendimento de pacientes adultos com quadro clínico de artrite aguda, em articulação nativa. CONTEÚDO: Artigos publicados entre 1970 e 2009, foram selecionados no banco de dados do MedLine através a das palavras-chave: monoartrite e emergência, assim como diretrizes internacionais foram buscadas no link http: sumsearch.uthsca.edu. Adicionalmente, referências destes a artigos, capítulos de livros e artigos históricos foram avaliados CONCLUSÃO: A artrite aguda é uma situação de emergência clínica, associada à fatores precipitantes e etiologias diversas. O correto atendimento, assim como o diagnóstico etiológico, assegura a recuperação e melhoria dos pacientes. Entre as etiologias de artrite aguda, deve-se salientar a importância da artrite infecciosa, devido suas complicações e sequelas, caso não seja instituído tratamento adequado.

Un caso de Diabetes Mellitus tipo 2 con ataque de gota tratada con terapéutica homeopática / A case of Type 2 Diabetes Mellitus with gout treated with homeopathic therapy

El presente trabajo tiene la finalidad de demostrar que los medicamentos homeopáticos son eficaces para controlar enfermedades como la Diabetes Mellitos y la Gota.

Gota: estudio descriptivo en el Estado de Sonora (México) / Gout: Descriptive study in Sonora (Mexico)

Objetivo. La gota es una enfermedad común en México, que muchas veces la vemos poliarticular y erosiva. Se informan las características clínicas de un grupo de pacientes residentes en el Estado de Sonora (México), determinando si son sobreproductores o hipoexcretores y si el diagnóstico había sido correcto antes de la consulta de Reumatología, siguiendo los criterios del Colegio Americano de Reumatología. Resultado: Se reunieron 72 (68 hombres y 4 mujeres), con edades de 26 a 69 años (media 49.3), evolución de 1 semana a 20 años (mediana 30 meses), 40 con hábitos de alcoholismo de intensidad diversa, 12 tomaban furosemida, 48 obesos, 20 con hipercolesterolemia y 24 con hipertrigliceridemia; 28 hipertensos, 3 diabéticos y 4 en insuficiencia renal. El cuadro fue poliarticular en 60, 44 tenían erosiones y el diagnóstico previo fue correcto en sólo 16 pacientes. 32 eran hipoexcretores, 24 sobreproductores y 16 con mecanismo mixto. Conclusión. Nuestra población es diferente a la informada en la literatura: 90 a 95 por ciento son hipoexcretores en contraste con y 44 por ciento en nuestra serie. La ingestión de alcohol fue el factor precipitante en más de la mitad de los pacientes. Se necesita difundir el conocimiento del cuadro clínico de esta enfermedad, que aunque comúnmente es mono u oligoarticular, la mayoría presentaron cuadro apoliarticular, con erosiones y sin diagnóstico antes de la consulta especializada