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.

Analysis of Wistar Rats Submitted to a Gout Model, Treated with Double Cryotherapy Protocol.

Gout arthritis commonly affects joint regions by deposition of crystals, promoting functional damage mainly during periods of exacerbation. Cryotherapy is a commonly used resource to contain inflammatory processes, however, its use during a gout crisis is not yet well understood. Therefore, the objective was to evaluate the parameters of Wistar rats submitted to an experimental gout model and treated with dual cryotherapy protocol. Twenty-one male Wistar rats were used, separated into three groups: control group (CG), lesion group (LG), and lesion + cryotherapy group (LCG). Gout model induction was through intra-articular injection, with urate crystal solution, in the right knee and cryoimmersion treatment was performed for 20 minutes at a temperature of 5° ± 2°C. Seven evaluations and two treatment moments were performed, and the following parameters were analyzed: joint edema, grip strength, joint disability, motor function, and leukocyte migration through synovial lavage. In the statistical analysis we used SPSS 20.0 with Generalized Linear Models, with least significant difference posttest, always with 5% significance level. The treatment reduced edema, promoted strength recovery, and was effective in reducing total leukocytes in the synovial fluid. No difference was observed between the injured groups for joint disability and motor function. Cryotherapy promoted edema reduction and increased pelvic limb grip strength in Wistar rats during the acute period.

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.

Management of Gout and Hyperuricemia in CKD.

Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of <6mg/dL (or <5mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.

Relevant aspects of imaging in the diagnosis and management of gout.

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.

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)

Oral treatment with Bifidobacterium longum 51A reduced inflammation in a murine experimental model of gout.

Gout is an acute inflammatory disease characterised by the presence of uric acid crystals in the joint. This event promotes neutrophil infiltration and activation that leads to tissue damage. We investigated here whether the oral administration of the probiotic strain Bifidobacterium longum 5(1A) (BL) could ameliorate monosodium urate crystal (MSU)-induced inflammation in a murine model of gout. Mice received oral administration of BL or saline daily for 7 days and then were injected with MSU in the knee cavity. Treatment with BL significantly alleviated the inflammatory parameters, as seen by reduced hypernociception, reduced neutrophil accumulation in the joint and myeloperoxidase activity in periarticular tissue. There was inhibition of the production of CXCL1 and interleukin(IL)-1ß in joints. Levels of the anti-inflammatory cytokine IL-10 were significantly higher in the knee tissue of mice treated with than control mice injected with MSU. In conclusion, oral BL treatment reduced the inflammatory response in an experimental murine model of gout, suggesting it may be useful as an adjuvant treatment in patients with gout.

Gout in the spine.

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.

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.

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

Photobiomodulation of pain and inflammation in microcrystalline arthropathies: experimental and clinical results.

OBJECTIVE: This article presents the results of laser therapy in crystal (hydroxyapatite, calcium pyrophosphate, and urates) deposition-induced arthritis in rats and the clinical applications in humans. BACKGROUND DATA: Microcrystalline arthropathies are prevalent among geriatric patients, who are more vulnerable to the side effects of drugs. The effectiveness of laser therapy for pain relief, free of side effects, has been reported in painful conditions. METHODS: Two milligrams of each of the above-mentioned crystals was injected in both joints of the back limbs in three groups of rats; these groups were then treated with laser irradiation. Three other groups received no treatment after the injections. We determined the plasmatic levels of inflammatory markers (fibrinogen, prostaglandin E2, and TNF(alpha)), tissues (prostaglandin E(2)) and conducted anatomopathological studies. Twenty-five patients with acute gout arthritis were randomized into two groups and treated over 5 days: group A, diclofenac 75 mg orally, twice a day; and group B, laser irradiation once a day. Forty-nine patients with knee chronic pyrophosphate arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day. Thirty patients with shoulder chronic hydroxyapatite arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day. RESULTS: Fibrinogen, prostaglandin E(2), and TNF(alpha) concentrations in the rats injected with crystals and treated with laser decreased significantly as compared with the groups injected with crystals without treatment. Both laser therapy and diclofenac achieved rapid pain relief in patients with acute gouty arthritis without significant differences in efficacy. Laser therapy was more effective than diclofenac in patients with chronic pyrophosphate arthropathy and in patients with chronic apatite deposition disease. CONCLUSION: Laser therapy represents an effective treatment in the therapeutic arsenal of microcrystalline arthropathies.

Involvement of the thoracic spine in tophaceous gout. A case report.

The presence of tophi involving the spine is an atypical complication of tophaceous gout and its diagnosis may be difficult. The authors present a case of tophaceous gout involving the thoracic spine and discuss the topic.

Hiperuricemia / Hyperuricemia

La hiperuricemia del punto de vista bioquímico esta determinada por el aumento de la concentración de los uratos séricos por encima de 6,5 mg/dl cifra en que supera su límite de solubilidad, situación en que se depositan a nivel de diferentes tejidos. La gota es la situación clínica que resulta del depósito de cristales de uratos monosódicos causado por una sobreproducción o por un déficit de excreción o ambos. Clínicamente se manifiesta por los episodios agudos articulares, los tofos, el depósito de ácido úrico a nivel renal y la litiasis urinaria. Frecuentemente se asocia a obesidad, hipertensión arterial, dislipemia, intolerancia a la glucosa elementos característicos del síndrome X cuyo elemento central es la resistencia a la insulina con la hiperinsulinemia concomitante. Estudios epidemiológicos han planteado su vinculación con la enfermedad coronaria y con muerte de causa cardiovascular, discutiendose si la hiperuricemia es en realidad un factor de riesgo vascular independiente. Existen numerosos trabajos que apoyan esta hipótesis y otros que establecen que no es un factor de riesgo independiente y que su vinculación con la enfermedad coronaria y la muerte cardiovascular es por la asociación con los factores de riesgo vascular. Esta controversia no esta aún aclarada. La hipertensión arterial y la hiperuricemia están frecuentemente asociados y frecuentemente precede al diagnóstico y tratamiento de la hipertensión arterial. La hipótesis que la hiperuricemia indica el daño vascular en hipertensos se ha señalado como posible ha sido avalada por diferentes autores. La posibilidad de que la hiperuricemia sea un factor de riesgo vascular independiente, lleva al planteo del tratamiento sistémico de la hiperuricemia asintomática, que en la actualidad se indica en aquellos pacientes con cifras de uratos séricos por encima de 9 mg/dl o excreción urinaria mayor de 1.000 mg/día. El tratamiento de la hiperuricemia-gota se basa en el control de los episodios agudos de artritis gotosa, en el control del paciente y prevención en el período intercrítico como a su vez el control de las complicaciones y de las afecciones asociadas(AU)

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