Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.829
Filtrar
1.
Medicine (Baltimore) ; 98(51): e18374, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860997

RESUMO

RATIONALE: Deposition of tophus is a common feature in chronic gout; however, signs and symptoms are not always well-pronounced in cases of uncommon sites. We report a rare case with a tophaceous tendonitis on the flexor hallucis longus (FHL) tendon with tarsal tunnel syndrome (TTS). This is the first surgical case of TTS by gouty tophi in FHL. PATIENT CONCERNS: A 55-year-old woman presented with a 6-month history of mild discomfort at the right foot, which gradually worsened in the past 3 weeks. The patient visited our outpatient clinic due to persistent and aggravating foot pain and swelling around the tarsal tunnel. DIAGNOSIS: The patient was diagnosed with hyperuricemia and diabetes mellitus with chronic kidney disease, and did not receive regular antigout treatments. Paresthesia was found along the distribution of medial and plantar nerve and tinel test was positive on tarsal tunnel. Biochemical examination showed she had raised serum uric acid (10.6 mg/dL) and decreased estimated glomerular filtration rate (69 mL/min/1.73 m). Conventional radiography examination showed negative pathology except soft tissue swelling. Magnetic resonance imaging revealed a fusiform mass within the FHL tendon and fluid collection around tarsal tunnel. INTERVENTIONS: Surgical exploration was performed to remove the mass. Inflammation fluid exploded out from FHL tendon sheath, which was later proven to have infiltration of monosodium urate crystal. Superficial dissection revealed a white chalky mass and posterior tibial nerve was significantly compressed by the tophus mass. OUTCOMES: The mass was removed and the symptoms were relieved at immediate postoperative period. LESSONS: A tophaceous tendonitis on FHL tendon can cause TTS and surgical decompression of the gout lesion can reduce the symptoms.


Assuntos
Gota/complicações , Síndrome do Túnel do Tarso/etiologia , Complicações do Diabetes , Feminino , Gota/diagnóstico , Gota/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Parestesia/etiologia , Parestesia/cirurgia , Insuficiência Renal Crônica/complicações , Síndrome do Túnel do Tarso/cirurgia , Tendinopatia/etiologia , Tendinopatia/cirurgia , Tendões/diagnóstico por imagem
2.
Zhonghua Nei Ke Za Zhi ; 58(10): 745-750, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594172

RESUMO

With the improvement of people's living conditions and the prolonged lifespan, gout and hyperuricemia have increasingly become common chronic diseases in daily clinical practice for other physicians in addition to rheumatologists, even including general practitioners and primary care doctors. The European League Against Rheumatism (EULAR) firstly issued recommendations on gout diagnosis and management in 2006, which has been updated several times. Using a Delphi consensus approach, 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout finally formulated eight main recommendations, which was published online in June 2019. Not only does this edition emphasize the role of specialists, joint puncture or tophus aspirates and ultrasound in diagnosis, but also calls on all clinicians to pay more attention to risk factors of gout and associated comorbidities.


Assuntos
Medicina Baseada em Evidências , Gota/diagnóstico , Hiperuricemia/diagnóstico , Guias de Prática Clínica como Assunto/normas , Humanos , Fatores de Risco
3.
Zhonghua Nei Ke Za Zhi ; 58(10): 751-757, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594173

RESUMO

Objective: To investigate the characteristics of body composition (BC) in gout patients and its clinical significance. Methods: Consecutive gout patients were recruited between August 2017 and December 2018. Demographic information, clinical characteristics and comorbidities were collected. BC was assessed by bioelectric impedance analysis including body fat percentage (BF%), trunk and limb BF%, appendicular skeletal muscle index. Overfat was defined by BF% ≥25% for male and ≥35% for female. The association between BC and serum uric acid (sUA) was evaluated by multiple linear regression. Results: A total of 362 gout patients were recruited with median age 38 (30, 52) years, 96.1% (348/362) were male. Mean sUA was (551±133) µmol/L. The mean BF% was (25.8±6.4)% with 53.6%(194/362) patients overfat. Male gout patients with overfat showed more affected joints [4(2, 6) vs. 2(2, 5)], higher sUA [(576±126)µmol/L vs. (523±134) µmol/L], higher prevalence of dyslipidemia [70.1%(131/187) vs. 54.0%(87/161)], metabolic syndrome [60.8%(118/187) vs. 28.0%(47/161)], fatty liver [58.2%(113/187) vs. 35.1%(59/161)] and hypertension [44.4%(83/187) vs. 25.5%(41/161)] than male patients with normal fat (all P<0.05). Their BF%, trunk BF% and limb BF% were positively correlated with the numbers of affected joints, sUA, metabolic syndrome, fatty liver, and hypertension, respectively (r=0.154-0.435, all P<0.05). Multivariable linear regression suggested that BF% (ß=4.29, P=0.020) and trunk BF% (ß=9.11, P=0.007), but not limb BF%, were positively correlated with sUA. Conclusion: Overfat is very common in gout patients. The proportion of trunk fat in male patients is positively correlated with sUA. When assessing obesity in gout patients clinically, body composition analysis should be performed simultaneously.


Assuntos
Composição Corporal/fisiologia , Gota/diagnóstico , Obesidade/epidemiologia , Ácido Úrico/sangue , Adulto , Dislipidemias/epidemiologia , Feminino , Gota/sangue , Gota/epidemiologia , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/sangue , Prevalência
5.
Int J Rheum Dis ; 22(8): 1445-1451, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31317680

RESUMO

AIM: To investigate the effects on hypercholesterolemia and hypertriglyceridemia in gouty patients receiving uric acid-lowering therapy (UALT). METHODS: A retrospective study was performed from January 2015 to December 2017 in gouty patients receiving UALT. A total of 124 gouty patients with hypercholesterolemia or hypertriglyceridemia who were administered UALT were monitored. Of the 124 patients with gout, 52 were treated with febuxostat, 29 were treated with allopurinol, and 43 were treated with benzbromarone. Cholesterol and triglyceride levels were recorded and analyzed following treatment for 8-10 weeks. RESULTS: We compared the efficacy of febuxostat, allopurinol, and benzbromarone. All therapies mildly influenced serum cholesterol and triglyceride levels. Febuxostat significantly decreased cholesterol and triglyceride levels in patients who did not receive lipid-lowering therapy. Allopurinol and benzbromarone modestly decreased triglyceride levels, but cholesterol levels were unaffected. CONCLUSION: Uric acid-lowering therapy benefits hyperlipidemia in gouty patients. Febuxostat effectively improved serum cholesterol and triglyceride levels compared to allopurinol and benzbromarone in patients with gout.


Assuntos
Colesterol/sangue , Supressores da Gota/uso terapêutico , Gota/tratamento farmacológico , Hipercolesterolemia/sangue , Hipertrigliceridemia/sangue , Triglicerídeos/sangue , Ácido Úrico/sangue , Adulto , Alopurinol/uso terapêutico , Benzobromarona/uso terapêutico , Biomarcadores/sangue , Febuxostat/uso terapêutico , Feminino , Gota/sangue , Gota/diagnóstico , Humanos , Hipercolesterolemia/diagnóstico , Hipertrigliceridemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Uricosúricos/uso terapêutico
6.
Nutrients ; 11(8)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31357560

RESUMO

Plant-based diets (PBDs) are associated with decreased risk of morbidity and mortality associated with important noncommunicable chronic diseases. Similar to animal-based food sources (e.g., meat, fish, and animal visceral organs), some plant-based food sources (e.g., certain soy legume products, sea vegetables, and brassica vegetables) also contain a high purine load. Suboptimally designed PBDs might consequently be associated with increased uric acid levels and gout development. Here, we review the available data on this topic, with a great majority of studies showing reduced risk of hyperuricemia and gout with vegetarian (especially lacto-vegetarian) PBDs. Additionally, type of ingested purines, fiber, vitamin C, and certain lifestyle factors work in concordance to reduce uric acid generation in PBDs. Recent limited data show that even with an exclusive PBD, uric acid concentrations remain in the normal range in short- and long-term dieters. The reasonable consumption of plant foods with a higher purine content as a part of PBDs may therefore be safely tolerated in normouricemic individuals, but additional data is needed in hyperuricemic individuals, especially those with chronic kidney disease.


Assuntos
Dieta Vegetariana , Gota/prevenção & controle , Hiperuricemia/prevenção & controle , Comportamento de Redução do Risco , Ácido Úrico/sangue , Biomarcadores/sangue , Gota/sangue , Gota/diagnóstico , Gota/epidemiologia , Humanos , Hiperuricemia/sangue , Hiperuricemia/diagnóstico , Hiperuricemia/epidemiologia , Valor Nutritivo , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco
7.
J Korean Med Sci ; 34(22): e155, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31172694

RESUMO

BACKGROUND: We aimed to assess the performance of the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for gout in Korean patients with acute arthritis and to compare the performance of the ACR/EULAR criteria to that of other sets of criteria for gout classification. METHODS: Patients with acute arthritis who underwent diagnostic arthrocentesis at one of the four participating rheumatology clinics were consecutively enrolled between February and December 2017. Crystal-proven gout was diagnosed upon confirming the presence of monosodium urate (MSU) crystals in patients with a clinical impression of gout as judged by the rheumatologist. The performance of the ACR/EULAR and other gout classification criteria, including the Rome, New York, American Rheumatism Association (ARA), Mexico, and Netherlands criteria, was analyzed regardless of the presence/absence of MSU crystals. RESULTS: The study enrolled 118 gout patients (all crystal-proven) and 95 non-gout patients. According to the area under the curve, the diagnostic performance was the highest for the ACR/EULAR classification criteria (sensitivity, 80.5%; specificity, 95.8%; area under the curve, 0.966), followed by the Netherlands, Rome, ARA, New York, and Mexico criteria. All six sets of criteria demonstrated lower sensitivity in patients exhibiting the first episode of acute arthritis. CONCLUSION: In Korean patients with acute arthritis, the ACR/EULAR classification criteria outperformed other sets of gout classification criteria even in the absence of information regarding the presence of MSU crystals. However, to enhance diagnostic sensitivity, synovial fluid analysis should be considered in patients with the first episode of acute arthritis.


Assuntos
Artrite/diagnóstico , Gota/diagnóstico , Doença Aguda , Adulto , Idoso , Área Sob a Curva , Artrite/complicações , Estudos de Casos e Controles , Feminino , Gota/classificação , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Curva ROC , República da Coreia , Líquido Sinovial/química , Líquido Sinovial/citologia
8.
Int J Rheum Dis ; 22(8): 1427-1434, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062512

RESUMO

OBJECTIVES: The emphasis on capturing patient-reported outcomes (PRO) is increasing, but gout-specific PRO are lacking. We evaluated the reliability and validity of the 24-item Gout Impact Scale (GIS) of the Gout Assessment Questionnaire 2.0 (GAQ2.0) in a multi-ethnic Asian population. METHODS: Participants with gout in an academic medical center in Singapore completed the GIS which comprises five scales. Confirmatory factor analyses (CFA) were performed. Known-groups validity, divergent validity and internal consistency were evaluated. RESULTS: We analyzed data of 267 participants (mean [SD] age 52.2 [16.08] years, 92.1% men and 76.0% Chinese). CFA based on the original GIS factor structure had good model fit based on Tucker-Lewis Index (TLI) of 0.946 but not when based on Root Mean Square Error Of Approximation (RMSEA), which was 0.123 (90% CI: 0.116-0.130). Internal consistency of GIS exceeded 0.7 in all except one scale, consistent with previous studies. Hypotheses related to known-groups validity were largely supported. Scores were significantly higher (ie greater impact) for participants reporting at least some problem on the EQ-5D-3L anxiety/ depression item across all GIS scales. Correlations between RAND-36 Physical Functioning (PF) scale and all five scales in the GIS were poor (Spearman rank correlation coefficients: -0.2355 to 0.0426), implying that GIS does not measure impact of gout on physical health. CONCLUSION: The GIS is valid and reliable for assessing gout-specific psychosocial functioning in a multi-ethnic Asian population.


Assuntos
Grupo com Ancestrais do Continente Asiático , Gota/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Gota/etnologia , Gota/fisiopatologia , Gota/psicologia , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Qualidade de Vida , Reprodutibilidade dos Testes , Singapura/epidemiologia , Comportamento Social , Adulto Jovem
9.
Hypertension ; 74(1): 95-101, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31079535

RESUMO

Serum urate is correlated with blood pressure (BP), and lowering urate may decrease BP, but a consistent effect has not been observed. Here, we evaluated whether pegloticase, a recombinant uricase conjugated to polyethylene glycol, which can lead to persistently low serum urate levels (<1 mg/dL), can modulate BP in subjects with chronic refractory gout. This post hoc analysis used results from two 6-month randomized clinical trials in which subjects were treated with 8 mg pegloticase every 2 or 4 weeks (q2w or q4w) or placebo. Responders in this study were defined as those individuals in whom a persistently low urate level (<6 mg/dL and usually <1 mg/dL) was maintained. Serial sitting BP was measured in 173 subjects, and estimated glomerular filtration rate was determined at baseline and after 3 and 6 months. Significant reductions in mean arterial pressure (MAP) from baseline to 6 months were noted in q2w responders ( P=0.0028), whereas reductions in MAP in other groups were not significant. Significant decreases in both systolic and diastolic BP paralleled the change in MAP. Of the 62% of q2w responders exhibiting persistent decreases in MAP, there were no significant differences in baseline age, sex, race, weight, body mass index, history of hypertension, hyperlipidemia, history of coronary artery disease, gout duration, MAP, serum urate, estimated glomerular filtration rate or urinary uric acid/creatinine ratio compared with those who did not lower MAP. No significant changes in estimated glomerular filtration rate occurred in any of the groups during the study. Responders to biweekly pegloticase who maintained a persistently lower serum urate level throughout the trial experienced significant reductions in both systolic and diastolic BP that were independent of changes in renal function. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00325195.


Assuntos
Supressores da Gota/uso terapêutico , Gota/tratamento farmacológico , Hipertensão/prevenção & controle , Polietilenoglicóis/uso terapêutico , Urato Oxidase/uso terapêutico , Adulto , Idoso , Determinação da Pressão Arterial/métodos , Doença Crônica , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Gota/complicações , Gota/diagnóstico , Humanos , Hipertensão/etiologia , Testes de Função Renal , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Resultado do Tratamento , Ácido Úrico/sangue
10.
Medicine (Baltimore) ; 98(16): e15265, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008969

RESUMO

INTRODUCTION: Spinal gout is rarely encountered in clinical practice, is easily misdiagnosed, and often remains undiagnosed. This paper aims to provide some clues that are the salient diagnostic features of spinal gout, particularly axial pain, radiculopathy, and myelopathy, as determined on the basis of our experience with a few cases as well as a literature review. METHODS: We retrospectively reviewed the clinical data of 5 patients that were treated for axial pain and neurological symptoms associated with spinal gout between 2014 and 2017 in our hospital. Herein, we systematically describe the clinical characteristics of 5 patients with spinal gout. The 5 patients included 4 men and 1 woman, aged between 24 and 75 years. The most common clinical presentation included spinal pain, radiculopathy, and myelopathy. Four of the 5 patients had a history of gout and elevated serum uric acid levels. RESULTS: Four patients underwent surgery, while the remaining patient underwent conservative treatment and biopsy due to poor general condition. Pathological examination of the surgical samples in the 4 surgical cases and the biopsy sample in the remaining case confirmed the presence of spinal gout tophi. The neurological symptoms of all 5 patients were relieved after treatment. CONCLUSION: Due to its rarity and lack of typical defining criteria, the diagnosis of spinal gout is quite difficult. We recommend that patients presenting with axial pain; radicular pain or myelopathy; and especially high uric acid levels, with or without a history of gout, should be evaluated for spinal gout. Timely pathological examination of surgical or biopsy samples would help confirm the diagnosis and enable practitioners to provide the appropriate treatment to prevent disease progression.


Assuntos
Gota/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Idoso , Feminino , Gota/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Coluna Vertebral/patologia , Ácido Úrico/sangue , Adulto Jovem
11.
Dtsch Med Wochenschr ; 144(8): e51-e57, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30986856

RESUMO

BACKGROUND: To examine clinical, comorbidity and demographic aspects of gout and to explore the routine clinical practice of gout treatment among general practitioners (G.P.'s) in southwest Germany. METHODS: Gout specific questionnaires were sent to all G.P.'s in Rhineland Palatinate (RL-P), through the Panel physicians' Association. Questionnaires consisted of items exploring epidemiological, medication and comorbidity data. Moreover, questions regarding clinical gout manifestations were included with an extra focus on therapy-refractory cases. Finally, G.P.'s were asked to rate the current care status of gout. RESULTS: Data from 4016 gout patients (age at diagnosis: 62.8 years, IQR 55 - 67.8) were collected. The majority of patients were male (75 %) with podagra being the most common gout manifestation (85 %). Chronic tophaceous courses were reported in 15 % (median 10 %, IQR 2 - 20) and spinal involvement in 2.7 % (median 0 %, IQR 0 - 2) of patients respectively. An average of 11.3 % cases (median 10 %, IQR 2.3 - 20) were defined as "hard-to-treat". However, biologic agents were not namely reported as applied treatments. 32 % of patients were diagnosed with gout by their G.P., whereas 68 % had to visit further physicians. A definite diagnosis could be reached after 3.1 months on average (median 0.3, IQR 0.1 - 1). CONCLUSIONS: In the era of biologic therapies there is a need for optimization of gout management. Important targets are the shortening of diagnostic periods and the prevention of chronic disease courses. Critical awareness of the disease and its comorbidities, standardized treatment and patient-training could be important steps toward this direction.


Assuntos
Medicina Geral/métodos , Gota/epidemiologia , Gota/terapia , Idoso , Artrite Gotosa/diagnóstico , Artrite Gotosa/epidemiologia , Artrite Gotosa/terapia , Comorbidade , Feminino , Medicina Geral/estatística & dados numéricos , Alemanha/epidemiologia , Gota/complicações , Gota/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Insuficiência Renal/complicações , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo
12.
Dermatol Online J ; 25(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30982305

RESUMO

Gout is a common inflammatory arthropathy with a high prevalence worldwide. Increased levels of uric acid in the blood lead to deposition of monosodium urate crystals in the joints, inflammation, and pain. Acute gout attacks are often sudden, monoarticular, and typically resolve within a week, whereas chronic gout is often polyarticular with baseline pain between attacks. In chronic gout, depositions of uric acid known as tophi can form throughout the body. Despite the high prevalence of gout and the frequency with which tophi occur, ulceration over tophi is surprisingly rare. We report the case of a 38-year-old man, undiagnosed with gout, who presented to clinic for evaluation of ulcers with chalky white granules. The wounds were determined to be ulcerated tophaceous gout. Risk factors for ulceration over tophi and reported treatments are discussed.


Assuntos
Gota/diagnóstico , Úlcera Cutânea/diagnóstico , Adulto , Gota/complicações , Gota/patologia , Humanos , Extremidade Inferior , Masculino , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia
13.
Scand J Rheumatol ; 48(4): 294-299, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31012370

RESUMO

Objectives: To study associations between different anthropometric measures and incident gout, and to find the best predictive measure. Method: We used the baseline investigation from the Malmö Diet and Cancer study, excluding cases of prevalent gout (n = 28 081). Cox regression for each anthropometric measurement was calculated per standard deviation increment for men and women, with hazard ratios (HRs) and 95% confidence intervals (CIs), using a hospital diagnosis of incident gout (M10) during follow-up as the outcome. Incremental C-statistics for each anthropometric measure were used to determine the measure with the best predictive capacity, in models adjusted for age, socio-economic data, lifestyle factors, comorbidities, and antihypertensive medications. Results: The study population included 11 049 men and 17 032 women, with 633 incident gout cases, 393 in men (3.6%) and 240 in women (1.4%). For both men and women, the five anthropometric measurements with highest C-statistics were weight, body mass index (BMI), waist circumference (WC), hip circumference, and waist-to-height ratio; in men, the measurement with the highest C-statistic was BMI (0.7361; fully adjusted HR 1.52, 95% CI 1.39-1.68), and in women WC (0.8085; fully adjusted HR 1.62, 95% CI 1.46-1.81). The increment in C-statistic with anthropometric measures was good, around 0.035. Waist-to-hip ratio, waist-to-hip-to-height ratio, body fat percentages, and especially A Body Shape Index had lower C-statistics. Conclusions: Both BMI and WC showed good predictive ability for incident gout. The clinically used cut-offs for BMI and WC appeared to be relevant in the assessment of increased risk of gout.


Assuntos
Índice de Massa Corporal , Gota , Circunferência da Cintura , Adulto , Antropometria/métodos , Distribuição da Gordura Corporal/métodos , Feminino , Gota/diagnóstico , Gota/epidemiologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Suécia/epidemiologia
14.
Clin Obes ; 9(2): e12296, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30815983

RESUMO

The aim of this study was to evaluate the prevalence of hyperuricemia and acute gout after laparoscopic sleeve gastrectomy (LSG). Risk factors for developing gout were also examined. Eighty-five patients underwent LSG were enrolled in this prospective study. Serum uric acid levels, gout attacks and total water levels % derived by bioimpedance were examined pre-operatively and 1 month post-operatively. Hyperuricemia was identified in 30.6% pre-operatively and in 18.82% of patients post-operatively. From the patients' group with pre-operative hyperuricemia, 53.9% were normalized, 46.2% had increased uric acid post-operatively while gout was observed in 11.5%. From the patients group without pre-operative hyperuricemia, hyperuricemia and gout were observed in 6.8% and 5.1% post-operatively, respectively. The relative risk for developing hyperuricemia was 6.2 (95% confidence interval [CI] 2.2-17.8) and for developing gout was 2.3 (95% CI 2.2-17.8). Statistical significant differences for gout among the groups with and without gout were indicated concerning pre-operative use of medications (P < 0.001), age (P = 0.025), post-operative uric acid levels (P < 0.001) and post-operative total water levels % (P = 0.048). The prevalence of hyperuricemia was 18.8% and gout attack of 7.1% 1 month after LSG. From the cohort of patients with pre-operative hyperuricemia, a significant proportion normalized uric acid, while 11.5% developed gout. Patients without hyperuricemia pre-operatively developed hyperuricemia and gout in 6.8% and 5.1% post-operatively, respectively. The patients who had gout were younger and had 37% water levels post-operatively.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Gastrectomia/efeitos adversos , Gota/epidemiologia , Hiperuricemia/epidemiologia , Laparoscopia/efeitos adversos , Ácido Úrico/sangue , Adulto , Cirurgia Bariátrica/métodos , Biomarcadores/sangue , Composição Corporal , Água Corporal/metabolismo , Feminino , Gastrectomia/métodos , Gota/sangue , Gota/diagnóstico , Gota/fisiopatologia , Grécia/epidemiologia , Humanos , Hiperuricemia/sangue , Hiperuricemia/diagnóstico , Hiperuricemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Regulação para Cima
15.
Int J Rheum Dis ; 22(6): 1046-1051, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30924303

RESUMO

OBJECTIVE: This study aimed to examine whether gout is causally associated with Alzheimer's disease. METHODS: I used the publicly available summary statistics datasets of three genome-wide association studies (GWASs) on gout as the exposure dataset and meta-analysis results of four GWAS datasets consisting of 17 008 cases with Alzheimer's disease and 37 154 controls of European descent as the outcome dataset. The data were subjected to 2-sample Mendelian randomization (MR) analysis using the inverse-variance weighted (IVW), weighted median, and MR-Egger regression methods. RESULTS: I selected seven independent single nucleotide polymorphisms (SNPs) from gout GWASs as instrumental variables (IVs) to improve inference. These SNPs were located at MAP3K11 (rs10791821), SLC2A9 (rs11722228, rs734553), GCKR (rs1260326), ABCG2 (rs2231142, rs2728125), and CNIH-2 (rs4073582). The IVW data did not support a causal association between gout and Alzheimer's disease (ß = 0.013, standard error [SE] = 0.017, P = 0.445). The MR-Egger regression indicated that directional pleiotropy did not bias the result (intercept = 0.002, P = 0.654); it also revealed no causal association between gout and Alzheimer's disease (ß = -0.013, SE = 0.076, P = 0.870). The weighted median approach yielded similar results (ß = 0.004, SE = 0.022, P = 0.846). Cochran's Q test indicated no evidence of heterogeneity between IV estimates based on individual variants, and the results of "leave-one-out" analysis demonstrated that no single SNP drove the IVW estimate. CONCLUSIONS: The MR analysis results did not support a causal association between gout and Alzheimer's disease.


Assuntos
Doença de Alzheimer/genética , Gota/genética , Polimorfismo de Nucleotídeo Único , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Estudos de Casos e Controles , Bases de Dados Genéticas , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Gota/diagnóstico , Gota/epidemiologia , Humanos , Análise da Randomização Mendeliana , Medição de Risco , Fatores de Risco
16.
Zhonghua Shao Shang Za Zhi ; 35(3): 224-227, 2019 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-30897871

RESUMO

On 17th June 2017, a 50 years old man with refractory gout was admitted in our hospital. During the treatment, he was accompanied by intermittent fever (39 to 40 ℃) of unknown origin for 60 days and gastrointestinal bleeding, with difficult wound repair. After comprehensive treatment of thorough debridement, vacuum sealing drainage, skin graft, skin flap repair, and drug administration, the patient was discharged fully recovered on post hospitalization day 104.


Assuntos
Febre/complicações , Hemorragia Gastrointestinal/complicações , Gota/terapia , Desbridamento , Drenagem , Gota/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Resultado do Tratamento , Cicatrização
17.
J Clin Lab Anal ; 33(5): e22868, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30803031

RESUMO

BACKGROUND: Hyperuricemia is the only biochemical index in the classification of acute gouty arthritis in American Rheumatism Association 1977 and the main basis of clinical diagnosis for most doctors. However, nearly half of the time gout occurs without hyperuricemia, especially in an acute attack,which leads to an urgent need to find a new substitute diadynamic criteria of gout. Xanthine and hypoxanthine, as precursors of uric acid, have been reported to be high in gout patients with hyperuricemia and presumed to be gout biomarkers. OBJECTIVES: To further explore the possibility of xanthine and hypoxanthine to be gout biomarkers as substitutes for uric acid. METHODS: A reversed-phase HPLC-UV method was employed for simultaneous quantitative detection of uric acid (UA), xanthine (X), and hypoxanthine (HX) in gout patients' (with and without hyperuricemia) and healthy persons' serum. RESULTS: The xanthine and hypoxanthine concentrations in gout patients with hyperuricemia and without hyperuricemia are higher than in healthy persons with a P < 0.001. CONCLUSIONS: This study supplements previous researches by confirming that xanthine and hypoxanthine are significantly elevated in gout patients' serum especially in patients' with normouricemia, which supported xanthine and hypoxanthine may have clinical application for the diagnosis of gout.


Assuntos
Gota/diagnóstico , Hipoxantina/sangue , Xantina/sangue , Análise Química do Sangue/normas , Cromatografia Líquida de Alta Pressão/métodos , Cromatografia Líquida de Alta Pressão/normas , Gota/sangue , Gota/etiologia , Humanos , Hiperuricemia/sangue , Limite de Detecção , Masculino , Reprodutibilidade dos Testes , Ácido Úrico/sangue
18.
World J Surg Oncol ; 17(1): 10, 2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621724

RESUMO

BACKGROUND: Although gout is a common disease, the presence of gouty tophi outside joints is rare and in literature, there is to date only one report of hepatic tophaceous nodule. We would like to highlight here the difficult diagnostic workup in a patient with history of cancer and the presence of a tophus inside the liver. Moreover, we address the possible etiologic role of chronic inflammation related to tophi and liver cancer. CASE PRESENTATION: We present the case of a 72-year-old man with a localization of gouty tophus in the liver, who thereafter developed a hepatocellular carcinoma (HCC) in the same site. The patient was followed up after surgery for left renal cancer from 1992 to 2011, when a hepatic nodule was discovered for the first time. After a detailed evaluation, the nodule was classified as a urate tophus of the liver. However, further follow-up showed that the nodule increased in size and changed its characteristics, bringing to the diagnosis of HCC. CONCLUSIONS: With the present case report, we would discuss the possible neoplastic degeneration of a gouty tophus and its etiologic role favouring cellular degeneration linked to chronic inflammation. We would also highlight the importance of histopathological evaluation of hepatic lesions in gouty patients at high risk of liver neoplasm, due to the difficulty in characterizing gouty tophi by imaging.


Assuntos
Carcinoma Hepatocelular/patologia , Gota/patologia , Neoplasias Hepáticas/patologia , Fígado/patologia , Idoso , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/cirurgia , Meios de Contraste/administração & dosagem , Gota/diagnóstico , Gota/cirurgia , Hepatectomia , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Neoplasias Hepáticas/diagnóstico , Imagem por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
20.
Arthritis Care Res (Hoboken) ; 71(3): 419-426, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29781577

RESUMO

OBJECTIVE: To understand what terms people seeking information about gout use most frequently in online searches and to explore the psychological and emotional tone of these searches. METHODS: A large de-identified data set of search histories from major search engines was analyzed. Participants who searched for gout (n = 1,117), arthritis (arthritis search control group, age and sex-matched, n = 2,036), and a random set of age and sex-matched participants (general control group, n = 2,150) were included. Searches were analyzed using Meaning Extraction Helper and Linguistic Inquiry and Word Count. RESULTS: The most frequent unique searches in the gout search group included gout-related and food-related terms. Those who searched for gout were most likely to search for words related to eating or avoidance. In contrast, those who searched for arthritis were more likely to search for disease- or health-related words. Compared with the general control group, higher information seeking was observed for the gout and arthritis search groups. Compared with the general control group, both the gout and arthritis search groups searched for more food-related words and fewer leisure and sex-related words. The searches of both the gout and arthritis search groups were lower in positivity and higher in the frequency of sadness-related words. CONCLUSION: The perception of gout as a condition managed by dietary strategies aligns with online information seeking about the disease and its management. In contrast, people searching for information about arthritis focus more on medical strategies. Linguistic analyses reflect greater disability in social and leisure activities and lower positive emotion for those searching for gout or arthritis.


Assuntos
Gota/psicologia , Gota/terapia , Linguística/métodos , Percepção , Ferramenta de Busca/métodos , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Gota/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA