1/108. Multicentric reticulohistiocytosis: a mimic of gout and rheumatoid arthritis.Multicentric reticulohistiocytosis is a rare cutaneous-articular disease that may mimic more common disorders such as rheumatoid arthritis or tophaceous gout. In one fourth of patients, it is a paraneoplastic process. This brief overview is aimed at physicians who care for patients with polyarthritis, to alert them to distinctive features that differentiate multicentric reticulohistiocytosis from the common arthritides.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
2/108. Case report. Initial manifestation of gout after carpal tunnel release.A carpal tunnel release was performed on a patient with recurrent carpal tunnel syndrome and asymptomatic hyperuricaemia with no prior history of gouty arthritis. Intraoperatively, the patient was found to have tenosynovitis without crystals or tophaceous deposits in the carpal tunnel. Postoperatively, the patient developed an acutely inflamed hand, which responded dramatically to anti-gout medications. We report this patient as an initial attack of gout after a carpal tunnel release.- - - - - - - - - - ranking = 0.16666666666667keywords = arthritis (Clic here for more details about this article) |
3/108. gout: beyond the stereotype.Not all gout presents with involvement of the big toe, and not all gout patients are middle-aged men. Chronic gout may mimic rheumatoid arthritis; hyperuricemia may develop in postmenopausal women and in organ transplant recipients who are being treated with immunosuppressive agents. Both classic and nonclassic cases may benefit from new therapeutic agents.- - - - - - - - - - ranking = 0.16666666666667keywords = arthritis (Clic here for more details about this article) |
4/108. Chronic tophaceous gouty arthritis mimicking rheumatoid arthritis.OBJECTIVES: To analyze the factors which differentiate chronic tophaceous arthritis from rheumatoid arthritis. methods: We describe two cases of chronic gouty arthritis masquerading as rheumatoid arthritis. The characteristic features of each of these two conditions and the diagnostic approach are discussed in light of relevant literature. RESULTS: The correct diagnosis was reached by the combination of accurate history taking (family history of gout, alcoholism, previous diuretic therapy and renal stones), guiding clinical features (subcutaneous tophaceous deposits) and specific radiological (assymetrical erosions with sclerotic margins and overlying edges) and laboratory findings (hyperuricemia and hyperuricosuria). It was confirmed by the identification of monosodium urate (MSU) crystals in the synovial and subcutaneous tissues. CONCLUSIONS: gout and rheumatoid arthritis rarely coexist. Chronic gouty arthritis may mimic rheumatoid arthritis, and vice-versa. Clinical suspicion supplemented by characteristic laboratory, radiological and histologic findings help at reaching an accurate diagnosis.- - - - - - - - - - ranking = 2.5keywords = arthritis (Clic here for more details about this article) |
5/108. adenine phosphoribosyltransferase deficiency: its inheritance and occurrence in a female with gout and renal disease.A deficiency of adenine phosphoribosyltransferase (APRT) enzyme activity to approximately 40% of normal has been found in erythrocytes from a young woman aged 24 years, who had suffered from recurrent gouty arthritis since 11 years of age. She also demonstrated considerable, although asymptomatic, renal impairment with a creatinine clearance of one-third normal. Her father had suffered from gouty arthritis but had a normal APRT activity; he was obese, had a high purine intake and was a regular beer drinker. The patient's mother was asymptomatic with a normal serum urate concentration, but demonstrated a similar reduction in APRT activity to that of her daughter. Eleven other asymptomatic members of the family also demonstrated a similar reduction in APRT activity in erythrocyte lysates. The pattern of inheritance was consistent with autosomal transmission. Concentrations of phosphoribosylpyrophospate (PRPP) in erythrocytes were within normal limits both in the subjects with deficient, and in those with normal, APRT activity. Partial purification of APRT enzyme from erythrocytes of the index case did not reveal any difference from the normal enzyme as far as Michaelis constants, heat stability, or mobility in polyacrylamide gel was concerned. No primary abnormality of lipoprotein metabolism was demonstrated either in the propositus or in other members of her family. Study of urate metabolism in the propositus indicated that, although urate production was within the normal range in absolute terms, there was increased incorporation of glycine into produced urate, usually taken as one index of de novo urate production. Impaired renal excretion of urate was also shown. Although detailed study of urate metabolism has not been undertaken in other family members with APRT deficiency, no conclusive relationship has yet been demonstrated between APRT deficiency and disordered urate metabolism.- - - - - - - - - - ranking = 0.33333333333333keywords = arthritis (Clic here for more details about this article) |
6/108. Lumbar radiculopathy secondary to gouty tophi in the filum terminale in a patient without systemic gout: case report.OBJECTIVE AND IMPORTANCE: Gouty arthritis and gouty tophi of the spine are very rare. We present a patient with the clinical manifestations of an intradural tumor and histologically proven gouty deposits in the filum terminale. CLINICAL PRESENTATION: The patient presented with typical symptoms of lumbar radiculopathy and neurogenic claudication. There was no evidence of peripheral gout. INTERVENTION: Imaging studies, including computed tomography and magnetic resonance imaging, demonstrated a 1-cm, round, intradural, calcified lesion at the L3 vertebral level, causing moderate spinal stenosis. The patient underwent a two-level laminectomy and removal of the mass. A pathological examination of the specimen revealed gouty deposits in the region of the filum terminale. CONCLUSION: Spinal involvement in gout is very rare, and intradural gouty deposits have not been previously described. Intradural gout should be considered in the differential diagnosis of intradural masses.- - - - - - - - - - ranking = 0.16666666666667keywords = arthritis (Clic here for more details about this article) |
7/108. Thoracic cord compression due to gout: a case report and literature review.An 82-year-old man developed progressive weakness of both legs 1 month prior to admission. He reported no previous history of trauma. spine radiography revealed marked thoracic and lumbar spondylosis. magnetic resonance imaging of the spine disclosed segmental stenosis with cord compression at T10-11 due to an extradural soft tissue lesion. Based on a diagnosis of thoracic spondylosis with cord compression, decompression laminectomy was performed. During the operation, fragile chalky-white material was noted over the epidural space, compressing the thoracic cord. The granular lesion was meticulously removed until the dura was identified and the cord was decompressed. Histologic examination of the surgical specimen revealed deposits of needle-like crystals that were consistent with monosodium urate, demonstrating that a gouty lesion of the thoracic spine had caused the cord compression. The patient had previously experienced several attacks of gouty arthritis of his feet. The postoperative serum uric acid concentration was 8.5 mg/dL. After surgery, he was treated with benzbromarone 100 mg per day. He was able to walk 3 months after the operation. A high index of suspicion of gouty involvement of the spine is necessary in patients with gout. Surgical decompression followed by regular administration of antigout drugs can provide satisfactory results.- - - - - - - - - - ranking = 0.16666666666667keywords = arthritis (Clic here for more details about this article) |
8/108. Monoarticular acromioclavicular joint gout: a case report.acromioclavicular joint gout is extremely rare. The case presented represents the first case of monoarticular acromioclavicular joint gout reported. It is also the first reported case of acromioclavicular joint gout in an immunosuppressed patient. The diagnostic pitfalls inherent in the evaluation of acute monoarticular arthritis in an immunosuppressed patient are illustrated. Furthermore, the case demonstrates one of the atypical presentations of gout that may occur in renal transplant patients taking cyclosporin A.- - - - - - - - - - ranking = 0.16666666666667keywords = arthritis (Clic here for more details about this article) |
9/108. diagnosis of crystal-induced arthritis by synovial fluid examination for crystals: lessons from an imperfect test.OBJECTIVE: diagnosis of the crystal-induced arthritides is primarily based on microscopic identification of crystals in synovial fluid. Therefore, we aimed to estimate the operating characteristics of this test and demonstrate its clinical use. methods: medline was searched for relevant studies. sensitivity and specificity of identification of crystals were calculated, as were measures of interobserver agreement. Likelihood ratios were calculated and curves constructed using the solutions to the Bayesian equations. RESULTS: Four studies were identified. The rates of interobserver agreement were low; the false-negative rates in identifying calcium pyrophosphate crystals were particularly high. Only one study allowed calculation of the test operating characteristics, and this was a study that used synthetic crystals and therefore may not be directly useful in a clinical setting. CONCLUSION: There is a paucity of data about the accuracy of crystal identification. As it is clearly not a perfectly sensitive and specific test, the most prudent diagnostic strategy, as with essentially all diagnostic tests, is to establish a posterior probability of disease from a prior probability, based on the clinical features of the patient. Determining the operating characteristics of this test in conventional and reference laboratories should be a research priority for high quality clinical research on crystal arthropathies.- - - - - - - - - - ranking = 0.66666666666667keywords = arthritis (Clic here for more details about this article) |
10/108. Tophaceous gout of the spine mimicking epidural infection: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Tophaceous gout uncommonly affects the axial skeleton. The clinical presentations of gout of the spine range from back pain to quadriplegia. gout that presents as back pain and fever may be difficult to distinguish from spinal infection. We present a case of a patient with tophaceous gout of the lumbar spine who was initially diagnosed with and treated for an epidural infection. The clinical and diagnostic features of tophaceous gout of the spine are reviewed. CLINICAL PRESENTATION: A 70-year-old man presented with a 2-day history of fever and back pain. A physical examination revealed that he had flank tenderness and evidence of polyarthritis affecting the elbows, knees, and right first metatarsophalangeal joint. A magnetic resonance imaging scan of the patient's lumbar spine showed an extensive area of abnormal gadolinium enhancement of the paramedian posterior soft tissues from L3 to S1 with an area of focal enhancement extending into the right L4-L5 facet joint. INTERVENTION: A laminectomy was performed at L4-L5, and a chalky white material in the facet joint was found eroding into the adjacent pars intra-articularis. light and polarizing microscopy confirmed the presence of gouty tophus. No evidence of infection was found. CONCLUSION: Gouty arthritis of the spine is rare. Thirty-seven previous cases have been reported. When the clinical presentation includes acute back pain and fever, differentiation of spinal gout from spinal infection may be difficult. The clinical suspicion of spinal gout may lead to the correct diagnosis by a less invasive approach than exploration and laminectomy.- - - - - - - - - - ranking = 0.33333333333333keywords = arthritis (Clic here for more details about this article) |
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