Clinical features of familial gout and effects of probable genetic association between gout and its related disorders

We examined whether the age at onset, gender, arthritic manifestations, and tophus formation in familial gout are different from those in nonfamilial gout, and we also examined the contributory effect of genetic association to the concurrence of hypertriglyceridemia, hypercholesterolemia, type 2 diabetes mellitus (DM), hypertension, obesity, and renal insufficiency with gout in Taiwan. A total of 21,373 gout patients' data from Ho-Ping Gout database were analyzed in this study retrospectively. The clinical and laboratory data were compared between familial and nonfamilial gout. Mean age at onset of gout in familial subjects was significantly 7.5 years lower than that of nonfamilial subjects (40.9 +/- 13.4 v 48.4 +/- 14.2 years, P =.0001), while gender, arthritic severity, and tophus formation were not significantly different between these 2 groups. Familial gout had lower serum triglyceride (TG), total cholesterol (TC), and percentage of hypertension than nonfamilial gout (182.4 +/- 125.3 v 195.9 +/- 135.8 mg/dL, P =.0001; 207.5 +/- 42.5 v 210.4 +/- 48.8 mg/dL, P =.0003; and 19.57% v 22.56%, P <.0001, respectively). Their serum creatinine, body mass index (BMI), and percentage of type 2 DM were not significantly different. Our results demonstrate that familial gout is associated with precocious onset. Furthermore, the contributory effect of genetic association to the concurrence of hyperlipidemia and hypertension with gout is less than that of environmental factors, while the effect of genetic association to the concurrence of obesity, type 2 DM, and renal insufficiency with gout is equivalent to that of environmental factors.     

山东沿海地区女性痛风临床特点的研究

对比分析172例女性痛风与1 067例男性痛风的临床特征、合并症及血生化检测指标,探讨山东沿海地区女性痛风的临床特点.结果显示,女性痛风有其独特的临床特点:发病年龄较晚;较少饮酒和肥胖;较易合并糖尿病和冠心病;较少合并痛风石;急性期较少使用药物缓解;较易出现上肢关节和足部其他跖趾关节的受累.提示在临床诊疗过程中应多加注意,以便早期发现、及时有效治疗并尽可能避免高危因素.     

“Clinical features of women with gout arthritis.” A systematic review

Clinically, gout is generally considered as a preferential male disease. However, it definitely does not occur exclusively in males. Our aim was to assess differences in the clinical features of gout arthritis between female and male patients. Five electronic databases were searched to identify relevant original studies published between 1977 and 2007. The included studies had to focus on adult patients with primary gout arthritis and on sex differences in clinical features. Two reviewers independently assessed eligibility and quality of the studies. Out of 355 articles, 14 were selected. Nine fulfilled the quality and score criteria. We identified the following sex differences in the clinical features of gout in women compared to men: the onset of gout occurs at a higher age, more comorbidity with hypertension or renal insufficiency, more often use of diuretics, less likely to drink alcohol, less often podagra but more often involvement of other joints, less frequent recurrent attacks. We found interesting sex differences regarding the clinical features of patients with gout arthritis. To diagnose gout in women, knowledge of these differences is essential, and more research is needed to understand and explain the differences , especially in the general population.     

Female gout: clinical and laboratory features

OBJECTIVE: To evaluate and compare clinical and laboratory features of gout in men and women. METHODS: Twenty-seven women and 31 men with gout underwent clinical and laboratory evaluation and review of medical records. RESULTS: Disease onset in women was a mean of 7 years later than in men. There were no differences between women and men regarding systemic hypertension, diabetes mellitus, hyperlipidemia, chronic renal failure, renal stones, ischemic heart disease, or heavy alcohol consumption. Tophaceous gout was similar in both groups, although female gender seemed to be protective against risk of developing tophi (odds ratio: 0.449; 95% confidence interval: 0.151-1.330). Podagra was more common in men, and women showed a higher frequency of upper limb joint involvement. Most patients had low urate excretion rates. Achieving disease control was similar in women and men. Of the 8 women who were premenopausal at disease onset, 7 had secondary causes for gout; 5 of the 8 had high serum urate despite treatment. CONCLUSION: Gout in women had a later onset and higher frequency of upper limb joint involvement in comparison to men. Those with premenopausal onset tended to be refractory to standard therapy.     

Clinical study of gout in North Kerala

IntroductionGout is a heterogeneous disorder, characterized by hyperuricaemia and urate crystal-induced arthritis. At a serum urate level, more than 6.8 mg/dL, the solubility limit of monosodium urate in the serum is reached and there is an increased risk of gout and renal stones.AimTo study the clinical pattern of gout in North Kerala and its associations.Materials and methodsPatients with clinical and laboratory features suggestive of gout, who attended the Rheumatology Division at Calicut Medical College between December 2006 and March 2009 were included in this study. Informed written consent was obtained from all the patients. Detailed history and clinical examination, including musculoskeletal examination, was done as per the proforma designed for this study.ResultsA total of 83 patients were diagnosed with gout, of which 14 patients were either lost to follow-up or were not willing to participate in this study and were excluded. Sixty-nine patients were included in the final analysis. The male to female ratio was 16:1, with a mean age at onset of 50.7 (± 10.72) years. The mean disease duration was 32 (± 23.88) months. First, metatarsophalangeal (MTP) joint was the most common joint involved in 91.3% cases. However, ankle joint involvement was the commonest in the initial episode (39%). Overall, 10% patients had polyarticular involvement. Tophi were present in 26%, bursal involvement in 2.8% and 7.2% had normouricemic gout. Mean serum uric acid level was 9.26 (± 2.27) mg%. About 40.5% were hypertensive while 46.3% were obese. Sixteen per cent had renal calculi but none had renal failure or nephrocalcinosis. Intercritical period was less than 1 year in most of the patients. Most of the patients were under excretors of uric acid. No patient in the study group had secondary gout.ConclusionIn our study, there was a significant male preponderance. The first attack of gout was in the fifth decade. First, MTP joint involvement occurred in > 90% while ankle joint was commonly involved in the initial attack. High incidence of renal calculi was noted.     

痛风性关节炎28例临床分析

目的增强对痛风性关节炎临床特点的认识,减少漏诊和误诊。方法采集0.5年来在我院门诊或住院的28例痛风性关节炎患者的生活习惯、家族史、合并疾病、误诊情况、每次发作的诱发因素及临床表现等资料。结果患者全部为男性,平均发病年龄为(50±16)岁。有家族史者1例(占3.6%)。平素常有高嘌呤饮食者9例(占32.1%)。以足第一跖趾、跗骨、踝和膝关节炎为首发表现者分别为19例(占67.9%)、5例(占17.9%)、3例(占10.7%)和1例(占3.6%);有手部掌指关节受累者3例(占10.7%);有痛风石者15例(占53.6%,含5例肾结石);有7例患者(占25.0%)曾误诊为其他疾病。结论痛风性关节炎是一种主要累及中年男性、以单或寡关节急性炎症为主要表现的疾病,以第一跖趾关节最常受累。其发病可能与不良的生活习惯相关,并常合并代谢综合征。     

痛风性关节炎262例临床分析及诊治体会

目的增强对痛风性关节炎临床特点的认识,减少漏诊和误诊。方法回顾性分析262例痛风性关节炎患者的临床表现和治疗效果。结果262例痛风性关节炎患者以中年男性多见;有痛风家族史者37例(10.3%);平时常有高嘌呤饮食者89例(30.5%);以足第一跖趾关节为首发表现者152例(58.0%);本病易误诊为其它疾病;痛风性关节炎急性发作期用非类固醇类抗炎药治疗能达到较好疗效,且副作用较小。结论痛风性关节炎是一种主要累及中年男性、以单或寡关节急性炎症为主要表现的疾病,第一跖趾关节受累最常见;其发病可能与不良的生活习惯有关。     

中药四妙丸加味治疗痛风的临床观察

目的 探讨痛风及高尿酸血症患者的异同及四妙丸加味治疗痛风的机制.方法 观察30例缓解期痛风患者、32例高尿酸血症患者和31名健康对照者超敏C反应蛋白(hsCRP)、胰岛素抵抗、尿酸、胆固醇、甘油三酯的区别.痛风组服用中药四妙丸加味14 d后复查hsCRP、胰岛素抵抗和尿酸.结果 痛风组hsCRP显著高于高尿酸血症组及健康对照组(P＜0.01),服用中药治疗后痛风组hsCRP显著下降(P＜0.01),尿酸变化无统计学意义.结论 中药四妙丸加味可能是通过减轻炎症反应达到治疗目的 .     

Female gout. Clinical spectrum and uric acid metabolism

We reviewed the clinical features and uric acid metabolism in 37 female patients with gout. In 32 female patients (86%), gout was diagnosed after menopause. Among the five premenopausal patients, four had renal insufficiency and one had superactivity of phosphoribosylpyrophosphate synthetase. More than 50% of the female patients had osteoarthritis, hypertension, or renal insufficiency or were treated with diuretics. Comparison with 220 male patients with gout showed that female patients developed gout significantly later, more frequently had associated diseases, and more often were receiving diuretics, whereas significantly more male than female patients had alcoholism. The articular features of gout were similar in both groups. However, the prevalence of tophi was higher and its localization different in female than in male patients. Female patients with gout had a higher mean serum urate concentration and a lower mean urinary uric acid excretion than did male patients with gout. These differences were significant and independent of the effects of age, renal insufficiency, alcoholism, or previous diuretic intake. Renal underexcretion of uric acid appears to be more severe in female than in male patients with gout.     

Demographic and clinical features of gout patients in Turkey: a multicenter study

Gout results from multifactor interactions between gender, age, genetic and environmental factors. Environmental factors underlying gout and precipitating factors triggering acute attacks might vary in different populations with different lifestyles. In this study, we aimed to collect data regarding the demographic and clinical features, comorbid factors, and precipitating factors associated with the initiation of acute attacks in gout patients in Turkey. A total of 312 patients were included in this study (mean age, 58.8 ± 13.8 years; female/male ratio, 55/257). The demographic features, alcohol intake, clinical and laboratory features, and comorbid conditions including obesity, diabetes mellitus, hyperlipidemia, hypertension, and coronary heart disease were noted in a standard questionnaire. Precipitating factors initiating acute attacks (if any) were also noted. The patients were divided into 4 groups according to the region of location as central Anatolian region, southeast Anatolian region, Aegean region, and Trakya region. Our results were compared according to the gender and the location of the patients. The mean age at the start of the symptoms was 10 years higher in women (60.4 ± 14.8 and 50.6 ± 13.5 years in women and men, respectively, p < 0.001).Obesity was present in 40.1 %, diabetes mellitus in 17.9 %, hyperlipidemia in 30.1 %, hypertension in 53.5 %, coronary artery disease in 17 %, and nephrolithiasis in 21.8 % of patients. Precipitating factors triggering gout flares were as follows: diet (high consumption of meat or fish) in 46.5 %, alcohol consumption in 15.7 %, diuretics in 8.3 %, diet or diuretics in 5.1 %, diet or alcohol in 4.5 %, diet or alcohol or diuretics in 1.6 %, others in 4.2 %, and none in 14.1 %. The presence of diabetes and diuretic use was more common among women. Use of diuretics is a more common trigger for gout flares among women. On the other hand, various comorbid conditions, such as obesity and hypertension, and triggers for gout flares may differ between patients living in different geographic regions. In summary, we reported the first data regarding clinical and demographic characteristics of gout in Turkey. The majority of our patients could describe at least one “trigger” that initiated gout flare. Both comorbid conditions and triggers of attack might differ between men and women, and in different geographic areas. Better knowledge of the modifiable risk factors can be useful for the management strategy to optimize long-term patient outcomes in local clinics.