Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome following spontaneous rupture of a gouty tophus

A 70-year-old man with a 30-year history of gout presented with a ruptured gouty tophus over the right lateral malleolus. After the debridement of the tophus, bilateral arthralgia and pitting edema were observed in his extremities. Treatments with antibiotics and nonsteroidal antiinflammatory drugs were ineffective. However, prednisolone therapy was highly effective, and the patient’s symptoms were rapidly ameliorated. Thus, we presume that rupture of a gouty tophus or its surgical treatment might contribute to the occurrence of RS3PE syndrome; however, in our case, the etiology of the syndrome remained unknown.     

中医治疗痛风临床观察

目的：观察中医药对痛风治疗的临床效果。方法：选取我院2004年10月～2010年9月间在我院进行治疗的痛风患者109例,将其分为观察组和对照组,其中观察组为54例,对照组为55例进行对比治疗。观察组采用传统中医疗法,对照组采用普通疗法,将两组治疗结果进行统计学分析。结果：观察组54例患者中有19例患者效果明显,24例患者对药物表现有效,11例患者无效,总有效率达79．63％;对照组中55例患者总有效率为94．55％,其中27例患者效果明显,25例患者有效,3例无效患者。结论：中医对痛风治疗有明显帮助,值得临床推广使用。     

痛风患者伴发疾病与诊治现状调查

目的了解痛风患者伴发疾病情况及目前痛风的诊治现状。方法采用现况调查方法,对2008年4月至10月就诊于北京大学人民医院风湿科门诊的200例痛风患者的一般资料、伴发疾病、诊断及治疗进行现场调查,并记录近3个月的血脂、血肌酐、血尿酸、尿常规结果,用肾脏病膳食改良试验（MDRD）公式计算肾小球滤过率。结果痛风患者伴发高血压、肥胖、肾结石、冠心病、脑梗死、糖尿病的分别为54．5％（109／200）、23．2％（42／181）、20．0％（40／200）、12．0％（24／200）、8．0％（16／200）和7．0％（14／200）。伴发高甘油三酯血症为53．7％（101／188）。63．7％（114／179）的患者有肾功能下降,15．1％（27／179）伴发慢性。肾脏病。200例患者中分别有124例（62％）、72例（36％）、12例（6％）和30例（15％）于痛风急性发作期使用非甾体抗炎药、秋水仙碱、糖皮质激素及降血尿酸药物。痛风间歇期,符合较公认降血尿酸治疗指征的患者中69．8％（81／116）接受过降血尿酸治疗,仅8．6％（10／116）血尿酸水平维持在0．06g／L以下。不符合降血尿酸治疗指征者中73．8％（48／65）也接受了降血尿酸治疗。结论痛风患者最常见的伴发疾病是高血压、高脂血症及肥胖,其次是肾结石、慢性肾脏病和冠心病等。非甾体抗炎药是痛风急性发作期首选治疗,患者降血尿酸治疗时机与目前国际上较公认的指征不一致,达到治疗目标的比例低。     

Xanthine oxidase inhibitory activity of some Indian medical plants

Xanthine oxidase inhibitory activity was assayed from six species belonging to different families traditionally used for the treatment of gout and related symptoms by indigenous people of India. The aqueous, methanol-water mixture and methanolic extract of these plants were used for the experiment. Of the 18 extracts assayed, 14 extracts demonstrated xanthine oxidase inhibitory activity at 100 microg/ml, among which 10 extracts showed an inhibition greater than 50% and IC(50) values below 100 microg/ml. The methanolic extracts of Coccinia grandis, Datura metel, Strychnos nux-vomica and Vitex negundo showed more than 50% inhibition, hence, they were screened for their in vivo hypouricaemic activity against potassium oxonate-induced hyperuricaemia in mice. Methanolic extracts of Coccinia grandis and Vitex negundo showed a significant decrease in the serum urate level (3.90+/-0.07 mg/dl, P<0.001) and (6.26+/-0.06 mg/dl, P<0.01), respectively, when compared to hyperuricaemic control (11.42+/-0.14 mg/dl). This effect is almost similar to the serum urate level of allopurinol (3.89+/-0.07 mg/dl).     

Veterinary diclofenac threatens Africa’s endangered vulture species

Veterinary diclofenac has been responsible for the devastation of three species of Gyps vulture on the Indian subcontinent, and it is now regarded as one of the worst environmental contaminants in the recent past. While measures have been taken to control the manufacture of veterinary diclofenac in South Asia, the promotion of diclofenac on the African continent poses a risk to vultures in this region. In Southern Africa, the species of greatest conservation concern is the Cape Griffon Vulture (Gyps coprotheres), as only 2900 breeding pairs remain in the wild. The objective of this study was to test if this species is toxicologically sensitive to diclofenac. In a single dose-toxicity study, two adult Cape Griffon Vultures with severe injuries, that were considered to have a very poor prognostic outcome, were dosed intravenously with diclofenac at 0.8 mg/kg. The changes in the clinical pathology were compared to the normal reference range established for 24 healthy Cape Griffon Vultures. Both birds died within 48 h of dosing. The clinical signs, clinical pathology, gross pathology and histopathological finding were typical for diclofenac toxicity. It would appear that the sensitivity of the Cape Griffon is similar to that of their Asian counterparts and the African White-backed Vulture (Gyps africanus). Diclofenac is almost certainly toxic to all Gyps vultures species and strong efforts must be taken to ensure that veterinary diclofenac products are not licensed or introduced to the African continent.     

Proteomic analysis of Down's syndrome patients with gout

BACKGROUND: In this study, the expression of hypoxanthine-guanine phosphoribosyl transferase (HPRT) in Down's syndrome patients with gout (DS/G) was determined, and possible underlying mechanisms of gout were characterized using proteomic tools. METHODS: Serum was obtained from DS/G, healthy controls and gout patients (without DS), recruited from the rheumatology clinic. Baseline enzyme assays were recorded and RT-PCR used to identify HPRT gene expression. 2-D electrophoresis and mass spectrometry were utilized to determine a plausible explanation concerning the mechanisms leading to increased uric acid levels in DS patients. RESULTS: Two DS patients were diagnosed with gouty arthritis. Their HPRT enzyme activity was slightly lower than that of normal controls. HPRT expression was also slightly decreased in DS/G patients compared with controls. Serum protein profiles of these two DS/G patients revealed that haptoglobin alpha chain and apolipoprotein A1 (ApoA1) were both significantly down-regulated. Protein expression was validated by immunoblot. CONCLUSION: Our results revealed that low levels of haptoglobin in the two DS/G patients were related to renal dysfunction may have affected uric acid excretion and caused gout. However, decreased ApoA1 revealed a positive correlation between defective lipid metabolism and gouty arthritis in DS/G patients.     

痛风性膝关节炎的关节镜诊断和治疗

目的探讨关节镜对痛风性膝关节炎的诊断价值和近期疗效。方法对37例痛风性膝关节炎患者作膝关节镜检查观察其镜下表现,多点取病变组织做病理检查,将水肿增厚的滑膜和尿酸盐结晶尽可能清除,彻底冲洗。术后观察手术疗效,常规服用治疗痛风的药物。结果术前16例误诊为其他关节炎者术中确诊为痛风性关节炎,21例术前拟诊痛风性关节炎术中得到进一步的证实。31例均获随访,时间2～36个月,膝关节肿胀、疼痛明显减轻,功能改善明显,Lysholm评分由术前53分到末次随访时提高到90分,疗效评定：优15例,良22例。结论关节镜手术能较直观诊断痛风性关节炎,近期疗效满意。     

Pharmacological basis for use of Lychnophora trichocarpha in gouty arthritis: anti-hyperuricemic and anti-inflammatory effects of its extract, fraction and constituents

Ethnopharmacological relevance

The ethanolic extract of Lychnophora trichocarpha Spreng. is used in Brazilian folk medicine to treat bruise, pain and inflammatory diseases.

Aim of the study

The present study aimed at investigating whether ethanolic extract of L. trichocarpha, its ethyl acetate fraction and its main bioactive compounds could be useful to treat gouty arthritis by countering hyperuricemia and inflammation.

Materials and methods

L. trichocarpha ethanolic extract (LTE), ethyl acetate fraction from ethanolic extract (LTA) and isolated compounds were evaluated for urate-lowering activity and liver xanthine oxidase (XOD) inhibition in oxonate-induced hyperuricemic mice. Anti-inflammatory activity in monosodium urate crystal-induced paw oedema, an experimental model of gouty arthritis, was also investigated.

Results

Crude ethanolic extract and its ethyl acetate fraction showed significant urate-lowering effects. LTE was also able to significantly inhibit liver xantine oxidase (XOD) activity in vivo at the dose of 250 mg/kg. Luteolin, apigenin, lupeol, lychnopholide and eremantholide C showed the anti-hyperuricemic activities among tested compounds. Apigenin also showed XOD inhibitory activity in vivo. Luteolin, lychnopholide, lupeol and eremantholide C, in turn, did not shown significant inhibitory activity towards this enzyme, indicating that this mechanism is not likely to be involved in urate-lowering effects of those compounds. LTE, LTA, lupeol, β-sitosterol, lychnopholide, eremantholide, luteolin and apigenin were also found to inhibit monosodium urate crystals-induced paw oedema in mice.

Conclusions

Ethanolic extract of Lychnophora trichocarpha and some of its bioactive compounds may be promising agents for the treatment of gouty arthritis since they possesses both anti-hiperuricemic and anti-inflammatory properties.