Hyperuricemia(HUA)is a condition associated with a high concentration of uric acid(UA)in the bloodstream and can cause gout and chronic kidney disease.The gut microbiota of patients with gout and HUA is significantly ...Hyperuricemia(HUA)is a condition associated with a high concentration of uric acid(UA)in the bloodstream and can cause gout and chronic kidney disease.The gut microbiota of patients with gout and HUA is significantly altered compared to that of healthy people.This article focused on the complex interconnection between alterations in the gut microbiota and the development of this disorder.Some studies have suggested that changes in the composition,diversity,and activity of microbes play a key role in establishing and progressing HUA and gout pathogenesis.Therefore,we discussed how the gut microbiota contributes to HUA through purine metabolism,UA excretion,and intestinal inflammatory responses.We examined specific changes in the composition of the gut microbiota associated with gout and HUA,highlighting key bacterial taxa and the metabolic pathways involved.Additionally,we discussed the effect of conventional gout treatments on the gut microbiota composition,along with emerging therapeutic approaches that target the gut microbiome,such as the use of probiotics and prebiotics.We also provided insights into a study regarding the gut microbiota as a possible novel therapeutic intervention for gout treatment and dysbiosis-related diagnosis.展开更多
BACKGROUND Gout is a disease characterized by hyperuricemia,and resultant deposition of uric acid crystals in tissues.While typically manifested as intraarticular crystals or tophi,gout can also cause pathology at ent...BACKGROUND Gout is a disease characterized by hyperuricemia,and resultant deposition of uric acid crystals in tissues.While typically manifested as intraarticular crystals or tophi,gout can also cause pathology at entheses.Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture.Furthermore,allografts can also be at risk of rupture in the setting of severe gout.We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction.CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs.She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years.This patient presented with pain and extensor lag.A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle.The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction.She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks.At twelve weeks,she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises.CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.展开更多
BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical m...BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical management and prognosis of these combined diseases.CASE SUMMARY A 57-year-old woman with a 20-year history of joint swelling,tenderness,and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA.The initial regimen of methotrexate,leflunomide,and celecoxib alleviated her symptoms,except for those associated with the knee.After symptom recurrence after medication cessation,her regimen was updated to include iguratimod,methotrexate,methylprednisolone,and folic acid,but her knee issues persisted.Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee,indicating coexistent SNRA and atypical knee gout.After postarthroscopic surgery to remove the synovium and urate crystals,and following a tailored regimen of methotrexate,leflunomide,celecoxib,benzbromarone,and allopurinol,her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year,indicating successful management of both conditions.CONCLUSION This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.展开更多
This paper reviews the pathogenesis,diagnostic criteria,and treatment means of gouty arthritis from the perspectives of Western medicine and Dai medicine in order to provide a reference for clinical medication.
BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swel...BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swelling in the affected joint.It frequently targets the lower extremities,such as the big toe.However,rarely,gout can manifest in atypical locations,including the hands,leading to an uncommon presentation known as gouty tenosynovitis.However,it can result in significant morbidity owing to the potential for severe complications,such as myonecrosis and compartment syndrome.CASE SUMMARY An 82-year-old male patient with a history of hypertension,cerebral infarction,Parkinson's disease,and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand.Imaging findings revealed forearm swelling,raising concerns of possible tenosynovitis,bursitis,septic arthritis,and compartment syndrome.A fasciotomy was performed to decompress the patient’s hands and forearms.The procedure revealed diffuse tenosynovitis,tophi with a pus-like discharge surrounding the carpal tunnel,and involvement of the flexor and extensor tendon sheaths.However,microbiological investigations,including Gram staining,acid-fast bacilli,tuberculosis,and nontuberculous mycobacteria,yielded negative results.The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis.Septic arthritis and infectious flexor tenosynovitis were ruled out.Serial debridement and inflammation control were initiated,followed by staged closure with a skin graft.CONCLUSION Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis.Cultures can be used to differentiate between gouty attacks,septic arthritis,and infectious tenosynovitis.Involvement of the flexor and extensor muscles,as in this case,is rare.This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.展开更多
Existing technologies used to detect monosodium urate(MSU)crystals for gout diagnosis are not ideal due to their low sensitivity and complexity of operation.The purpose of this study was to explore whether aggregation...Existing technologies used to detect monosodium urate(MSU)crystals for gout diagnosis are not ideal due to their low sensitivity and complexity of operation.The purpose of this study was to explore whether aggregation-induced emission luminogens(AIEgens)can be used for highly specific imaging of MSU crystals to assist in the diagnosis of gout.First,we developed a series of luminogens(i.e.,tetraphenyl ethylene(TPE)-NH_(2),TPE-2NH_(2),TPE-4NH_(2),TPE-COOH,TPE-2COOH,TPE-4COOH,and TPE-Ketoalkyne),each of which was then evenly mixed with MSU crystals.Next,optimal fluorescence imaging of each of the luminogens was characterized by a confocal laser scanning microscope(CLSM).This approach was used for imaging standard samples of MSU,hydroxyapatite(HAP)crystals,and mixed samples with 1:1 mass ratio of MSU/HAP.We also imaged samples from mouse models of acute gouty arthritis,HAP deposition disease,and comorbidities of interest.Subsequently,CLSM imaging results were compared with those of compensated polarized light microscopy,and we assessed the biosafety of TPE-Ketoalkyne in the RAW264.7 cell line.Finally,CLSM time series and three-dimensional imaging were performed on MSU crystal samples from human gouty synovial fluid and tophi.As a promising candidate for MSU crystal labeling,TPE-Ketoalkyne was found to detect MSU crystals accurately and rapidly in standard samples,animal samples,and human samples,and could precisely distinguish gout from HAP deposition disease.This work demonstrates that TPE-Ketoalkyne is suitable for highly specific and timely imaging of MSU crystals in gouty arthritis and may facilitate future research on MSU crystal-related diseases.展开更多
Objective Evidence from prospective studies on the consumption of tea and risk of gout is conflicting and limited.We aimed to investigate the potential causal effects of tea intake on gout using Mendelian randomizatio...Objective Evidence from prospective studies on the consumption of tea and risk of gout is conflicting and limited.We aimed to investigate the potential causal effects of tea intake on gout using Mendelian randomization(MR).Methods Genome-wide association studies in UK Biobank included 349376 individuals and successfully discovered single-nucleotide polymorphisms linked to consumption of one cup of tea per day.Summary statistics from the Chronic Kidney Disease Genetics consortium included 13179 cases and 750634 controls for gout.Two-sample MR analyses were used to evaluate the relationship between tea consumption and gout risk.The inverse-variance weighted(IVW)method was used for primary analysis,and sensitivity analyses were also conducted to validate the potential causal effect.Results In this study,the genetically predicted increase in tea consumption per cup was associated with a lower risk of gout in the IVW method(OR:0.90;95%CI:0.82–0.98).Similar results were found in weighted median methods(OR:0.88;95%CI:0.78–1.00),while no significant associations were found in MR-Egger(OR:0.89;95%CI:0.71–1.11),weighted mode(OR:0.80;95%CI:0.65–0.99),and simple mode(OR:1.01;95%CI:0.75–1.36).In addition,no evidence of pleiotropy was detected by MR-Egger regression(P=0.95)or MR-PRESSO analysis(P=0.07).Conclusion This study provides evidence for the daily consumption of an extra cup of tea to reduce the risk of gout.展开更多
BACKGROUND Carpal tunnel syndrome(CTS)has been associated with gout and type 2 diabetes mellitus(T2DM).However,due to insufficient clinical understanding of goutrelated CTS and reliance on the diagnostic importance of...BACKGROUND Carpal tunnel syndrome(CTS)has been associated with gout and type 2 diabetes mellitus(T2DM).However,due to insufficient clinical understanding of goutrelated CTS and reliance on the diagnostic importance of elevated serum uric acid levels,such cases are prone to missed diagnosis,misdiagnosis,and delayed treatment.In addition,the effect of T2DM on gout-induced carpal tunnel syndrome has not been reported.CASE SUMMARY Herein,we present an unusual case of CTS and motor dysfunction caused by miliary tophaceous gout and T2DM.The patient presented to the hand and foot clinic with paresthesia of the fingers of both hands,especially at night.The patient was diagnosed with type 2 diabetes a month ago.Ultrasonography revealed bilateral transverse carpal ligament thickening with median nerve compression during hospitalization.The patient was successfully treated with carpal tunnel decompression and tendon release.The postoperative pathological examination revealed typical gout nodules.This case suggests that the presence of T2DM could accelerate tophi formation and worsen CTS symptoms,although no definitive proof in this regard has been described previously.CONCLUSION Tophi formation may most likely cause the co-occurrence of CTS and flexor dysfunction in gout and incipient diabetes patients.展开更多
BACKGROUND Hyperuricemia is a prerequisite for the development of gout.Elevated serum uric acid(UA)levels result from either overproduction or decreased excretion.A positive correlation between serum UA levels,cirrhos...BACKGROUND Hyperuricemia is a prerequisite for the development of gout.Elevated serum uric acid(UA)levels result from either overproduction or decreased excretion.A positive correlation between serum UA levels,cirrhosis-related complications and the incidence of nonalcoholic fatty liver disease has been established,but it is unknown whether hyperuricemia results in worsening cirrhosis outcomes.We hypothesize that patients with cirrhosis will have poorer gout outcomes.AIM To explore the link between cirrhosis and the incidence of gout-related complications.METHODS This was a cross-sectional study.The national inpatient sample was used to identify patients hospitalized with gout,stratified based on a history of cirrhosis,from 2001 to 2013 via the International Classification of Diseases,Ninth Revision,Clinical Modification codes.Primary outcomes were mortality,gout complications and joint interventions.Theχ^(2)test and independent t-test were performed to assess categorical and continuous data,respectively.Multiple logistic regression was used to control for confounding variables.RESULTS Patients without cirrhosis were older(70.37±13.53 years vs 66.21±12.325 years;P<0.05).Most patients were male(74.63%in the cirrhosis group vs 66.83%;adjusted P<0.05).Patients with cirrhosis had greater rates of mortality(5.49%vs 2.03%;adjusted P<0.05),gout flare(2.89%vs 2.77%;adjusted P<0.05)and tophi(0.97%vs 0.75%;adjusted P=0.677).Patients without cirrhosis had higher rates of arthrocentesis(2.45%vs 2.21%;adjusted P<0.05)and joint injections(0.72%vs 0.52%;adjusted P<0.05).CONCLUSION Gout complications were more common in cirrhosis.Those without cirrhosis had higher rates of interventions,possibly due to hesitancy with performing these interventions given the higher complication risk in cirrhosis.展开更多
Rheumatoid arthritis (RA) and gout are common diseases, but their coexistence is rare. We describe the case of a 76-year-old man with hypertension who had been treated for gout for 20 years on allopurinol and colchici...Rheumatoid arthritis (RA) and gout are common diseases, but their coexistence is rare. We describe the case of a 76-year-old man with hypertension who had been treated for gout for 20 years on allopurinol and colchicine. He was seen in consultation for deforming polyarthritis of the small and large joints, which had been evolving for about 2 years. The acute episode occurred 10 days earlier with the onset of bilateral and symmetrical polyarthritis affecting the large and small joints. The physical examination revealed a peripheral joint syndrome with ulnar gale force deformities of the hands and several buttonhole deformities of the fingers. In addition, there were nodules, some of which were fistulised, giving rise to a chalky slurry. The biology revealed an inflammatory syndrome in addition to rheumatoid factors and ACPA, which were elevated. Biological analysis of the nodular fluid revealed clusters of sodium urate crystals and ultrasound scans of the joints revealed a double-contour appearance in several joints. The diagnosis of RA was made using the 2010 ACR/EULAR criteria. The patient was treated as an outpatient with corticosteroids before being put on methotrexate. It is important to understand that these two conditions can occur at the same time, so it is important to consider them when treating patients with gout or RA.展开更多
Chief physician Zhou Lamei performs diagnosis and treatment according to syndrome differentiation,and proposes the method of combining internal treatment with external treatment of traditional Chinese medicine and pay...Chief physician Zhou Lamei performs diagnosis and treatment according to syndrome differentiation,and proposes the method of combining internal treatment with external treatment of traditional Chinese medicine and paying attention to the adjustment of eating habits and lifestyle,which has certain advantages in relieving acute attack,reducing uric acid,reducing gout complications caused by disease development and reducing adverse reactions of western medicine,and is of great significance to the treatment of gout onset and hyperuricemia control.展开更多
Background:Gout is an inflammatory joint disease.Modern pharmacological studies have shown that Zanthoxylum bungeanum(Z.bungeanum)has significant anti-inflammatory and osteoprotective effects.This study is aimed to ex...Background:Gout is an inflammatory joint disease.Modern pharmacological studies have shown that Zanthoxylum bungeanum(Z.bungeanum)has significant anti-inflammatory and osteoprotective effects.This study is aimed to explore the therapeutic effect of Z.bungeanum on gouty arthritis.Methods:Firstly,the compounds in the water extract of Z.bungeanum(WZB)were analyzed by UPLC-QE-Orbitrap-MS/MS.The compounds and disease targets were predicted using SwissTargetPrediction platform and GeneCards database,and the candidate targets were acquired by taking the intersection.Next,the protein interaction network was constructed and the hub genes were screened using String platform and Cytoscape software.Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes analysis of hub genes were performed using Metascape platform.Finally,the disease-pathway-target-drug-component network diagram was constructed to obtain the active components and targets for treating disease,and the affinity between components and targets were predicted by applying Discovery Studio software.In vitro,using an acute gout model of RAW 264.7 macrophages induced by Monosodium Urate to evaluate the anti-inflammatory effect of WZB on Gout.Meanwhile,we established a mice model of hyperuricemia and measured the serum xanthine oxidase(XOD)activity and uric acid(UA)contents.Results:A total of 20 chemical components were identified from WZB,mainly alkaloid components.The network pharmacology results showed that Dihydrobungeanool,Quercetin,Hydroxy-α-sanshool and Hydroxy-ɛ-sanshool were the main active components of WZB against gout.MAPK1,PIK3CA,EGFR and TLR1 proteins were the main targets of WZB in the treatment of gout.Pathways in cancer,PI3K/Akt signaling pathway,Th17 cell differentiation and MAPK signaling pathway were closely related to anti-gout.Molecular docking results have shown that Dihydrobungeanool may be the main active ingredient of WZB for gout treatment,and PIK3CA is the main potential target.The cellular gout model showed that WZB significantly reduced IL-1βand TNF-αinflammatory factor levels and influenced the expression of PI3K protein.In addition,WZB administration effectively reduced UA levels and XOD activity in the serum of mice with hyperuricemia.Conclusion:Our study results suggest that WZB could treat gout by acting on PIK3CA gene target to reduce the level of inflammatory factors,and reduce XOD activity to lower UA levels.展开更多
Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in join...Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in joints and tophi in soft tissues. Spinal gout is rare and never mentioned in our context. It can appear as acute back pain, radiculopathy, spinal cord compression, spondylodiscitis or neoplasic/infectious epiduritis. Our aim was to share our surgical experience and proceed of a Literature review. Cases Presentation: Between January and August 2022, two patients male were surgically cared, aged of 42 and 60 years old. The gout was unknown in the youngest and poorly followed in the eldest. There was no past medical history of tuberculosis or immunodeficiency in both. The early diagnosis retained was unspecific lumbar spondylodiscitis due to clinical features: Patients complained both of lower back pain with initial fever. It was of a progressive left L5S1 deficit with erectile defect and dysuria in the first case and a progressive paraplegia without sphincter disorders in the second case. We proceeded with a lumbar laminectomy with a biopsy on both patients. The spinal tophus was ligamentous in one case and arthro-ligamentous in the other. There was a progressive motor recovery from postoperative Day-2 till postoperative Month-1. A probabilistic antituberculosis treatment was promptly initiated postoperatively based on radioclinic features while waiting for histologic proof. The Polymerase Chain Reaction (PCR) of Mycobacterium tuberculosis was negative and the histology was of a chronic calcified osteitis with dense fibrosis in both. The anti-gout treatment was implemented after 15 days with blood test evidence. A rheumatologic follow-up was also initiated and adjuvant physio-therapy. The results were very satisfactory from 4 - 6 months with independent walking. Discussion Conclusion: Spinal Gout may be suggested in 40-male-old faced with any acute rachialgia with neuro deficit with dubious neuro-imaging.展开更多
Because of the continuous improvement of the quality of life,the population of gout patients is also increasing,which seriously affects the quality of life of patients.Traditional Chinese medicine compound has a long ...Because of the continuous improvement of the quality of life,the population of gout patients is also increasing,which seriously affects the quality of life of patients.Traditional Chinese medicine compound has a long history and remarkable clinical effect in treating gout patients,and has been widely used.Intestinal flora and its metabolites are the focus of current research,which can promote intestinal mucosal barrier,improve immunity and improve metabolism.The regulation of intestinal flora can reduce serum uric acid and inhibit inflammation to fight gouty arthritis.Moreover,the mechanism of intestinal flora is related to the spleen in Chinese medicine theory.Therefore,this study discusses the research mechanism and clinical application of traditional Chinese medicine compound in treating gout by regulating intestinal flora,and provides theoretical basis for the clinical application of traditional Chinese medicine and the expansion of new dosage forms.展开更多
Tenosynovitis represents a common clinical condition characterized by inflam-mation of the synovium that encases the tendon sheath.Although tenosynovities may be noted in any tendon in the body,extremities such as han...Tenosynovitis represents a common clinical condition characterized by inflam-mation of the synovium that encases the tendon sheath.Although tenosynovities may be noted in any tendon in the body,extremities such as hand,and foot remain the sites of high predilection to acquire this condition.The predominant cause of this predilection rests in the intricate tendon arrangements in these extremities that permit fine motor actions.This editorial explores the common causes and the complications associated with this condition to improve the understanding of the readers of this common condition encountered in our everyday clinical practice.展开更多
BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underre...BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported.This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout.Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo,the patient underwent emergency decompression surgery for both wrists at different time points.Postoperatively,he exhibited complete recovery of sensory and motor functions,with no recurrence at long-term follow-up.Favorable outcomes were achieved through immediate decompression surgery,anti-inflammatory medications,postoperative active and passive range-of-motion exercises,and intermittent wrist splinting.Prompt diagnosis and surgical intervention,when necessary,are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS.An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.展开更多
Acute articular rheumatism(AAR)primarily affects children aged 5 to 15,causing fever and non-suppurative arthritis,and can lead to severe heart problems such as mitral stenosis and aortic insufficiency.Descriptions of...Acute articular rheumatism(AAR)primarily affects children aged 5 to 15,causing fever and non-suppurative arthritis,and can lead to severe heart problems such as mitral stenosis and aortic insufficiency.Descriptions of early years by Hippocrates and Galen were expanded in a in the 19^(th) century by Jean-Baptiste Bouillaud,who linked AAR to heart complications.An exploration of the historical development of AAR can be beneficial to further medical understanding.Time period between Renaissance and mid-20^(th) century unveiled a series of hallmarks in diagnosis,symptomatology,feverous attacks and treatment.As research method,a documentary research related to the subject.Of great importance concerning AAR’s understanding are Hippocrates’early descriptions,Jerome Cardan’s Renaissance distinction between“morbus articularis”and podagral(gout),and Jean-Baptiste Bouillaud’s 19^(th)-century linkage of AAR to heart disease.Furthermore,contributions from Théodore-Hermann Meynet,Louis Bard,and Edmond Weill were pivotal in clarifying the clinical and cardiac aspects of the disease.During 19^(th) century new diagnostic factors like visceral lesions and clearer understanding of chemical and mineral drugs supplied novel approaches.In the 20^(th) century,research in the United States confirmed the streptococcal cause of AAR,marking an advancement of great significance in the understanding the cause of AAR,as well as its progression.Even since the ancient times AAR has been recognized.Various nominations described the disease,while gradually physicians understood the causes and the nature of the disease,as philosophical physiology gave space to clinical anatomy and medical science of the mechanized era.Advancements made during the last centuries aided in AAR further understanding.The comprehension of the evolution of AAR is crucial in order to appreciate its current medical perspective and treatment.展开更多
·AIM: To characterize the clinical features of ocular surface in gout patients in coastal area of Shandong Province in China. ·METHODS: A total of 380 consecutive gout patients were examined from January 201...·AIM: To characterize the clinical features of ocular surface in gout patients in coastal area of Shandong Province in China. ·METHODS: A total of 380 consecutive gout patients were examined from January 2011 to May 2011. According to the course of gout, patients were divided into group A (【5 years), B (5 -10 years) and C (】10 years). Group D (control group) was consist of 50 healthy subjects. Eyelids, lateral canthus, medial canthus, palpebral conjunctiva, sclera and cornea, anterior chamber, lens, anterior vitreous were examined by slit lamp to find whether there were deposition of uric acid crystals, ocular vascular tortuosity, redness and subconjunctival hemorrhage. The ophthalmic exams of visual acuity, intraocular pressure, fundus were used to assess any gout-related eye disease. ·RESULTS: Uric acid crystals were found in 3 patients and the positions of the deposite were in corneal stroma, corneal epithelium and superficial stroma, and sclera respectively. The incidence was 0.79% . Dilatated and tortuous blood vessels in conjunctiva and sclera surface were found in 38 (23.8% ), 40 (44.0% ), 58 (45.0% ), 9 (18.0% ) patients in groups A, B, C and D, respectively. The differences between group B and D, group C and D were statistically significant( 【0.01, 【0.01).Transparent vesicles with metal -like reflected light in subconjunctiva were seen in 26 (16.2%), 29 (31.9%), 41 (31.8%), 2 (4.00%) patients in groups A, B, C and D, respectively. The differences between A and D, B and D, C and D were statistically significant ( 【0.05, 【0.01, 【0.01). Subconjunctival hemorrhage was found in all groups, the difference among the four groups showed no statistically significance. · CONCLUSION: Gout can cause ocular surface abnormalities, such as tophi deposition, subconjunctival transparent vesicles and hemorrhage, and vascular changes. These features have important clinical significance in early detection of the gout and prevention of eye injury. ·展开更多
AIM To summarize clinical presentations and treatment optionsof spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation.METHODS The authors reviewed 68 pub...AIM To summarize clinical presentations and treatment optionsof spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation.METHODS The authors reviewed 68 published cases of spinal gout, which were collected by searching "spinal gout" on Pub Med from 2000 to 2014. The data were analyzed for clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, and treatment choices. RESULTS Of the 68 patients reviewed, the most common clinical presentation was back or neck pain in 69.1% of patients. The most common laboratory study was elevated uric acid levels in 66.2% of patients. The most common diagnostic image finding was hypointense lesion of the gout tophi on the T1-weighted magnetic resonance imaging scan. The most common surgical treatment performed was a laminectomy in 51.5% and non-surgical treatment was performed in 29.4% of patients.CONCLUSION Spinal gout most commonly present as back or neck pain with majority of reported patients with elevated uric acid. The diagnosis of spinal gout is confirmed with the presence of negatively birefringent monosodium urate crystals in tissue. Treatment for spinal gout involves medication for the reduction of uric acid level and surgery if patient symptoms failed to respond to medical treatment.展开更多
文摘Hyperuricemia(HUA)is a condition associated with a high concentration of uric acid(UA)in the bloodstream and can cause gout and chronic kidney disease.The gut microbiota of patients with gout and HUA is significantly altered compared to that of healthy people.This article focused on the complex interconnection between alterations in the gut microbiota and the development of this disorder.Some studies have suggested that changes in the composition,diversity,and activity of microbes play a key role in establishing and progressing HUA and gout pathogenesis.Therefore,we discussed how the gut microbiota contributes to HUA through purine metabolism,UA excretion,and intestinal inflammatory responses.We examined specific changes in the composition of the gut microbiota associated with gout and HUA,highlighting key bacterial taxa and the metabolic pathways involved.Additionally,we discussed the effect of conventional gout treatments on the gut microbiota composition,along with emerging therapeutic approaches that target the gut microbiome,such as the use of probiotics and prebiotics.We also provided insights into a study regarding the gut microbiota as a possible novel therapeutic intervention for gout treatment and dysbiosis-related diagnosis.
文摘BACKGROUND Gout is a disease characterized by hyperuricemia,and resultant deposition of uric acid crystals in tissues.While typically manifested as intraarticular crystals or tophi,gout can also cause pathology at entheses.Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture.Furthermore,allografts can also be at risk of rupture in the setting of severe gout.We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction.CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs.She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years.This patient presented with pain and extensor lag.A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle.The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction.She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks.At twelve weeks,she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises.CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.
基金Supported by Natural Science Foundation of Guangdong Province,No.2023A1515011213。
文摘BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical management and prognosis of these combined diseases.CASE SUMMARY A 57-year-old woman with a 20-year history of joint swelling,tenderness,and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA.The initial regimen of methotrexate,leflunomide,and celecoxib alleviated her symptoms,except for those associated with the knee.After symptom recurrence after medication cessation,her regimen was updated to include iguratimod,methotrexate,methylprednisolone,and folic acid,but her knee issues persisted.Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee,indicating coexistent SNRA and atypical knee gout.After postarthroscopic surgery to remove the synovium and urate crystals,and following a tailored regimen of methotrexate,leflunomide,celecoxib,benzbromarone,and allopurinol,her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year,indicating successful management of both conditions.CONCLUSION This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.
基金National Natural Science Foundation of China(82360895)Yunnan Provincial Science and Technology Department Basic Research Program of Traditional Chinese Medicine Joint Special(2019FF002-028)+2 种基金Yunnan Key Laboratory of Formulated Granules(202105AG070014)Yunnan Provincial Department of Education Science Research Fund Project(2024Y371)National Administration of Traditional Chinese Medicine High-level Key Discipline Construction Project‘Dai Pharmacy’(zyyzdxk-2023192).
文摘This paper reviews the pathogenesis,diagnostic criteria,and treatment means of gouty arthritis from the perspectives of Western medicine and Dai medicine in order to provide a reference for clinical medication.
文摘BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swelling in the affected joint.It frequently targets the lower extremities,such as the big toe.However,rarely,gout can manifest in atypical locations,including the hands,leading to an uncommon presentation known as gouty tenosynovitis.However,it can result in significant morbidity owing to the potential for severe complications,such as myonecrosis and compartment syndrome.CASE SUMMARY An 82-year-old male patient with a history of hypertension,cerebral infarction,Parkinson's disease,and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand.Imaging findings revealed forearm swelling,raising concerns of possible tenosynovitis,bursitis,septic arthritis,and compartment syndrome.A fasciotomy was performed to decompress the patient’s hands and forearms.The procedure revealed diffuse tenosynovitis,tophi with a pus-like discharge surrounding the carpal tunnel,and involvement of the flexor and extensor tendon sheaths.However,microbiological investigations,including Gram staining,acid-fast bacilli,tuberculosis,and nontuberculous mycobacteria,yielded negative results.The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis.Septic arthritis and infectious flexor tenosynovitis were ruled out.Serial debridement and inflammation control were initiated,followed by staged closure with a skin graft.CONCLUSION Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis.Cultures can be used to differentiate between gouty attacks,septic arthritis,and infectious tenosynovitis.Involvement of the flexor and extensor muscles,as in this case,is rare.This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.
基金Thisworkwas supported by the Shanghai Science and Technology Committee(No.22dz1204700)the NationalKeyR&D Program of China(Nos.2020YFA0803800 and 2017YFE0132200)+2 种基金the National Natural Science Foundation of China(Nos.82072510,21907034,21788102,21525417,and 51620105009)the Natural Science Foundation of Guangdong Province(Nos.2019B030301003 and 2016A030312002)the Innovation and Technology Commission of Hong Kong(No.ITC-CNERC14S01).
文摘Existing technologies used to detect monosodium urate(MSU)crystals for gout diagnosis are not ideal due to their low sensitivity and complexity of operation.The purpose of this study was to explore whether aggregation-induced emission luminogens(AIEgens)can be used for highly specific imaging of MSU crystals to assist in the diagnosis of gout.First,we developed a series of luminogens(i.e.,tetraphenyl ethylene(TPE)-NH_(2),TPE-2NH_(2),TPE-4NH_(2),TPE-COOH,TPE-2COOH,TPE-4COOH,and TPE-Ketoalkyne),each of which was then evenly mixed with MSU crystals.Next,optimal fluorescence imaging of each of the luminogens was characterized by a confocal laser scanning microscope(CLSM).This approach was used for imaging standard samples of MSU,hydroxyapatite(HAP)crystals,and mixed samples with 1:1 mass ratio of MSU/HAP.We also imaged samples from mouse models of acute gouty arthritis,HAP deposition disease,and comorbidities of interest.Subsequently,CLSM imaging results were compared with those of compensated polarized light microscopy,and we assessed the biosafety of TPE-Ketoalkyne in the RAW264.7 cell line.Finally,CLSM time series and three-dimensional imaging were performed on MSU crystal samples from human gouty synovial fluid and tophi.As a promising candidate for MSU crystal labeling,TPE-Ketoalkyne was found to detect MSU crystals accurately and rapidly in standard samples,animal samples,and human samples,and could precisely distinguish gout from HAP deposition disease.This work demonstrates that TPE-Ketoalkyne is suitable for highly specific and timely imaging of MSU crystals in gouty arthritis and may facilitate future research on MSU crystal-related diseases.
基金supported by grants from the Natural Science Foundation of China(No.82102199)the General Program of Shanghai Municipal Commission of Health and Family Planning(No.202040479).
文摘Objective Evidence from prospective studies on the consumption of tea and risk of gout is conflicting and limited.We aimed to investigate the potential causal effects of tea intake on gout using Mendelian randomization(MR).Methods Genome-wide association studies in UK Biobank included 349376 individuals and successfully discovered single-nucleotide polymorphisms linked to consumption of one cup of tea per day.Summary statistics from the Chronic Kidney Disease Genetics consortium included 13179 cases and 750634 controls for gout.Two-sample MR analyses were used to evaluate the relationship between tea consumption and gout risk.The inverse-variance weighted(IVW)method was used for primary analysis,and sensitivity analyses were also conducted to validate the potential causal effect.Results In this study,the genetically predicted increase in tea consumption per cup was associated with a lower risk of gout in the IVW method(OR:0.90;95%CI:0.82–0.98).Similar results were found in weighted median methods(OR:0.88;95%CI:0.78–1.00),while no significant associations were found in MR-Egger(OR:0.89;95%CI:0.71–1.11),weighted mode(OR:0.80;95%CI:0.65–0.99),and simple mode(OR:1.01;95%CI:0.75–1.36).In addition,no evidence of pleiotropy was detected by MR-Egger regression(P=0.95)or MR-PRESSO analysis(P=0.07).Conclusion This study provides evidence for the daily consumption of an extra cup of tea to reduce the risk of gout.
基金Supported by Science and Technology Bureau of Jining,No.2021YXNS115.
文摘BACKGROUND Carpal tunnel syndrome(CTS)has been associated with gout and type 2 diabetes mellitus(T2DM).However,due to insufficient clinical understanding of goutrelated CTS and reliance on the diagnostic importance of elevated serum uric acid levels,such cases are prone to missed diagnosis,misdiagnosis,and delayed treatment.In addition,the effect of T2DM on gout-induced carpal tunnel syndrome has not been reported.CASE SUMMARY Herein,we present an unusual case of CTS and motor dysfunction caused by miliary tophaceous gout and T2DM.The patient presented to the hand and foot clinic with paresthesia of the fingers of both hands,especially at night.The patient was diagnosed with type 2 diabetes a month ago.Ultrasonography revealed bilateral transverse carpal ligament thickening with median nerve compression during hospitalization.The patient was successfully treated with carpal tunnel decompression and tendon release.The postoperative pathological examination revealed typical gout nodules.This case suggests that the presence of T2DM could accelerate tophi formation and worsen CTS symptoms,although no definitive proof in this regard has been described previously.CONCLUSION Tophi formation may most likely cause the co-occurrence of CTS and flexor dysfunction in gout and incipient diabetes patients.
文摘BACKGROUND Hyperuricemia is a prerequisite for the development of gout.Elevated serum uric acid(UA)levels result from either overproduction or decreased excretion.A positive correlation between serum UA levels,cirrhosis-related complications and the incidence of nonalcoholic fatty liver disease has been established,but it is unknown whether hyperuricemia results in worsening cirrhosis outcomes.We hypothesize that patients with cirrhosis will have poorer gout outcomes.AIM To explore the link between cirrhosis and the incidence of gout-related complications.METHODS This was a cross-sectional study.The national inpatient sample was used to identify patients hospitalized with gout,stratified based on a history of cirrhosis,from 2001 to 2013 via the International Classification of Diseases,Ninth Revision,Clinical Modification codes.Primary outcomes were mortality,gout complications and joint interventions.Theχ^(2)test and independent t-test were performed to assess categorical and continuous data,respectively.Multiple logistic regression was used to control for confounding variables.RESULTS Patients without cirrhosis were older(70.37±13.53 years vs 66.21±12.325 years;P<0.05).Most patients were male(74.63%in the cirrhosis group vs 66.83%;adjusted P<0.05).Patients with cirrhosis had greater rates of mortality(5.49%vs 2.03%;adjusted P<0.05),gout flare(2.89%vs 2.77%;adjusted P<0.05)and tophi(0.97%vs 0.75%;adjusted P=0.677).Patients without cirrhosis had higher rates of arthrocentesis(2.45%vs 2.21%;adjusted P<0.05)and joint injections(0.72%vs 0.52%;adjusted P<0.05).CONCLUSION Gout complications were more common in cirrhosis.Those without cirrhosis had higher rates of interventions,possibly due to hesitancy with performing these interventions given the higher complication risk in cirrhosis.
文摘Rheumatoid arthritis (RA) and gout are common diseases, but their coexistence is rare. We describe the case of a 76-year-old man with hypertension who had been treated for gout for 20 years on allopurinol and colchicine. He was seen in consultation for deforming polyarthritis of the small and large joints, which had been evolving for about 2 years. The acute episode occurred 10 days earlier with the onset of bilateral and symmetrical polyarthritis affecting the large and small joints. The physical examination revealed a peripheral joint syndrome with ulnar gale force deformities of the hands and several buttonhole deformities of the fingers. In addition, there were nodules, some of which were fistulised, giving rise to a chalky slurry. The biology revealed an inflammatory syndrome in addition to rheumatoid factors and ACPA, which were elevated. Biological analysis of the nodular fluid revealed clusters of sodium urate crystals and ultrasound scans of the joints revealed a double-contour appearance in several joints. The diagnosis of RA was made using the 2010 ACR/EULAR criteria. The patient was treated as an outpatient with corticosteroids before being put on methotrexate. It is important to understand that these two conditions can occur at the same time, so it is important to consider them when treating patients with gout or RA.
文摘Chief physician Zhou Lamei performs diagnosis and treatment according to syndrome differentiation,and proposes the method of combining internal treatment with external treatment of traditional Chinese medicine and paying attention to the adjustment of eating habits and lifestyle,which has certain advantages in relieving acute attack,reducing uric acid,reducing gout complications caused by disease development and reducing adverse reactions of western medicine,and is of great significance to the treatment of gout onset and hyperuricemia control.
基金This work was supported by the Project of State Administration of Traditional Chinese Medicine of Sichuan Province of China(No.2020HJZX001)。
文摘Background:Gout is an inflammatory joint disease.Modern pharmacological studies have shown that Zanthoxylum bungeanum(Z.bungeanum)has significant anti-inflammatory and osteoprotective effects.This study is aimed to explore the therapeutic effect of Z.bungeanum on gouty arthritis.Methods:Firstly,the compounds in the water extract of Z.bungeanum(WZB)were analyzed by UPLC-QE-Orbitrap-MS/MS.The compounds and disease targets were predicted using SwissTargetPrediction platform and GeneCards database,and the candidate targets were acquired by taking the intersection.Next,the protein interaction network was constructed and the hub genes were screened using String platform and Cytoscape software.Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes analysis of hub genes were performed using Metascape platform.Finally,the disease-pathway-target-drug-component network diagram was constructed to obtain the active components and targets for treating disease,and the affinity between components and targets were predicted by applying Discovery Studio software.In vitro,using an acute gout model of RAW 264.7 macrophages induced by Monosodium Urate to evaluate the anti-inflammatory effect of WZB on Gout.Meanwhile,we established a mice model of hyperuricemia and measured the serum xanthine oxidase(XOD)activity and uric acid(UA)contents.Results:A total of 20 chemical components were identified from WZB,mainly alkaloid components.The network pharmacology results showed that Dihydrobungeanool,Quercetin,Hydroxy-α-sanshool and Hydroxy-ɛ-sanshool were the main active components of WZB against gout.MAPK1,PIK3CA,EGFR and TLR1 proteins were the main targets of WZB in the treatment of gout.Pathways in cancer,PI3K/Akt signaling pathway,Th17 cell differentiation and MAPK signaling pathway were closely related to anti-gout.Molecular docking results have shown that Dihydrobungeanool may be the main active ingredient of WZB for gout treatment,and PIK3CA is the main potential target.The cellular gout model showed that WZB significantly reduced IL-1βand TNF-αinflammatory factor levels and influenced the expression of PI3K protein.In addition,WZB administration effectively reduced UA levels and XOD activity in the serum of mice with hyperuricemia.Conclusion:Our study results suggest that WZB could treat gout by acting on PIK3CA gene target to reduce the level of inflammatory factors,and reduce XOD activity to lower UA levels.
文摘Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in joints and tophi in soft tissues. Spinal gout is rare and never mentioned in our context. It can appear as acute back pain, radiculopathy, spinal cord compression, spondylodiscitis or neoplasic/infectious epiduritis. Our aim was to share our surgical experience and proceed of a Literature review. Cases Presentation: Between January and August 2022, two patients male were surgically cared, aged of 42 and 60 years old. The gout was unknown in the youngest and poorly followed in the eldest. There was no past medical history of tuberculosis or immunodeficiency in both. The early diagnosis retained was unspecific lumbar spondylodiscitis due to clinical features: Patients complained both of lower back pain with initial fever. It was of a progressive left L5S1 deficit with erectile defect and dysuria in the first case and a progressive paraplegia without sphincter disorders in the second case. We proceeded with a lumbar laminectomy with a biopsy on both patients. The spinal tophus was ligamentous in one case and arthro-ligamentous in the other. There was a progressive motor recovery from postoperative Day-2 till postoperative Month-1. A probabilistic antituberculosis treatment was promptly initiated postoperatively based on radioclinic features while waiting for histologic proof. The Polymerase Chain Reaction (PCR) of Mycobacterium tuberculosis was negative and the histology was of a chronic calcified osteitis with dense fibrosis in both. The anti-gout treatment was implemented after 15 days with blood test evidence. A rheumatologic follow-up was also initiated and adjuvant physio-therapy. The results were very satisfactory from 4 - 6 months with independent walking. Discussion Conclusion: Spinal Gout may be suggested in 40-male-old faced with any acute rachialgia with neuro deficit with dubious neuro-imaging.
文摘Because of the continuous improvement of the quality of life,the population of gout patients is also increasing,which seriously affects the quality of life of patients.Traditional Chinese medicine compound has a long history and remarkable clinical effect in treating gout patients,and has been widely used.Intestinal flora and its metabolites are the focus of current research,which can promote intestinal mucosal barrier,improve immunity and improve metabolism.The regulation of intestinal flora can reduce serum uric acid and inhibit inflammation to fight gouty arthritis.Moreover,the mechanism of intestinal flora is related to the spleen in Chinese medicine theory.Therefore,this study discusses the research mechanism and clinical application of traditional Chinese medicine compound in treating gout by regulating intestinal flora,and provides theoretical basis for the clinical application of traditional Chinese medicine and the expansion of new dosage forms.
文摘Tenosynovitis represents a common clinical condition characterized by inflam-mation of the synovium that encases the tendon sheath.Although tenosynovities may be noted in any tendon in the body,extremities such as hand,and foot remain the sites of high predilection to acquire this condition.The predominant cause of this predilection rests in the intricate tendon arrangements in these extremities that permit fine motor actions.This editorial explores the common causes and the complications associated with this condition to improve the understanding of the readers of this common condition encountered in our everyday clinical practice.
文摘BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported.This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout.Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo,the patient underwent emergency decompression surgery for both wrists at different time points.Postoperatively,he exhibited complete recovery of sensory and motor functions,with no recurrence at long-term follow-up.Favorable outcomes were achieved through immediate decompression surgery,anti-inflammatory medications,postoperative active and passive range-of-motion exercises,and intermittent wrist splinting.Prompt diagnosis and surgical intervention,when necessary,are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS.An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.
文摘Acute articular rheumatism(AAR)primarily affects children aged 5 to 15,causing fever and non-suppurative arthritis,and can lead to severe heart problems such as mitral stenosis and aortic insufficiency.Descriptions of early years by Hippocrates and Galen were expanded in a in the 19^(th) century by Jean-Baptiste Bouillaud,who linked AAR to heart complications.An exploration of the historical development of AAR can be beneficial to further medical understanding.Time period between Renaissance and mid-20^(th) century unveiled a series of hallmarks in diagnosis,symptomatology,feverous attacks and treatment.As research method,a documentary research related to the subject.Of great importance concerning AAR’s understanding are Hippocrates’early descriptions,Jerome Cardan’s Renaissance distinction between“morbus articularis”and podagral(gout),and Jean-Baptiste Bouillaud’s 19^(th)-century linkage of AAR to heart disease.Furthermore,contributions from Théodore-Hermann Meynet,Louis Bard,and Edmond Weill were pivotal in clarifying the clinical and cardiac aspects of the disease.During 19^(th) century new diagnostic factors like visceral lesions and clearer understanding of chemical and mineral drugs supplied novel approaches.In the 20^(th) century,research in the United States confirmed the streptococcal cause of AAR,marking an advancement of great significance in the understanding the cause of AAR,as well as its progression.Even since the ancient times AAR has been recognized.Various nominations described the disease,while gradually physicians understood the causes and the nature of the disease,as philosophical physiology gave space to clinical anatomy and medical science of the mechanized era.Advancements made during the last centuries aided in AAR further understanding.The comprehension of the evolution of AAR is crucial in order to appreciate its current medical perspective and treatment.
文摘·AIM: To characterize the clinical features of ocular surface in gout patients in coastal area of Shandong Province in China. ·METHODS: A total of 380 consecutive gout patients were examined from January 2011 to May 2011. According to the course of gout, patients were divided into group A (【5 years), B (5 -10 years) and C (】10 years). Group D (control group) was consist of 50 healthy subjects. Eyelids, lateral canthus, medial canthus, palpebral conjunctiva, sclera and cornea, anterior chamber, lens, anterior vitreous were examined by slit lamp to find whether there were deposition of uric acid crystals, ocular vascular tortuosity, redness and subconjunctival hemorrhage. The ophthalmic exams of visual acuity, intraocular pressure, fundus were used to assess any gout-related eye disease. ·RESULTS: Uric acid crystals were found in 3 patients and the positions of the deposite were in corneal stroma, corneal epithelium and superficial stroma, and sclera respectively. The incidence was 0.79% . Dilatated and tortuous blood vessels in conjunctiva and sclera surface were found in 38 (23.8% ), 40 (44.0% ), 58 (45.0% ), 9 (18.0% ) patients in groups A, B, C and D, respectively. The differences between group B and D, group C and D were statistically significant( 【0.01, 【0.01).Transparent vesicles with metal -like reflected light in subconjunctiva were seen in 26 (16.2%), 29 (31.9%), 41 (31.8%), 2 (4.00%) patients in groups A, B, C and D, respectively. The differences between A and D, B and D, C and D were statistically significant ( 【0.05, 【0.01, 【0.01). Subconjunctival hemorrhage was found in all groups, the difference among the four groups showed no statistically significance. · CONCLUSION: Gout can cause ocular surface abnormalities, such as tophi deposition, subconjunctival transparent vesicles and hemorrhage, and vascular changes. These features have important clinical significance in early detection of the gout and prevention of eye injury. ·
文摘AIM To summarize clinical presentations and treatment optionsof spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation.METHODS The authors reviewed 68 published cases of spinal gout, which were collected by searching "spinal gout" on Pub Med from 2000 to 2014. The data were analyzed for clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, and treatment choices. RESULTS Of the 68 patients reviewed, the most common clinical presentation was back or neck pain in 69.1% of patients. The most common laboratory study was elevated uric acid levels in 66.2% of patients. The most common diagnostic image finding was hypointense lesion of the gout tophi on the T1-weighted magnetic resonance imaging scan. The most common surgical treatment performed was a laminectomy in 51.5% and non-surgical treatment was performed in 29.4% of patients.CONCLUSION Spinal gout most commonly present as back or neck pain with majority of reported patients with elevated uric acid. The diagnosis of spinal gout is confirmed with the presence of negatively birefringent monosodium urate crystals in tissue. Treatment for spinal gout involves medication for the reduction of uric acid level and surgery if patient symptoms failed to respond to medical treatment.