Remission in Gout: Concepts From a Patient Perspective

We present a case of an 82-year-old female with a history of right total knee arthroplasty 11 years prior. She was admitted after a ground-level fall and developed progressive pain and swelling of her right knee. She had no history of complications with her total knee replacement. Radiographs of the knee and hip were negative for acute fracture, dislocation, or hardware malalignment. Knee aspiration was performed and revealed inflammatory exudate, synovial fluid consistent with crystal arthropathy, and no bacterial growth. She was diagnosed with an acute gout flare, and her symptoms significantly improved with steroids and anti-inflammatory treatment. Orthopedic surgeons should be aware of the potential for crystal arthropathy in the setting of total joint arthroplasty and evaluate for crystals before treating a presumed periprosthetic joint infection.

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IL-1 inhibitor anakinra is an effective alternative to standard treatments for reducing pain due to acute gout flare

Clinical Research in Practice The Journal of Team Hippocrates ◽

10.22237/crp/1593562920 ◽

2020 ◽

Vol 6 (2) ◽

Author(s):

Cheryl Craig

Keyword(s):

Standard Treatment ◽

Clinical Decision ◽

Effective Alternative ◽

Acute Gout ◽

Double Blind ◽

Double Blind Placebo ◽

Active Comparator ◽

Gout Flare ◽

Gout Flares

A clinical decision report appraising Janssen CA, Voshaar MAHO, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019;58(8):1344-1352. https://doi.org/10.1093/rheumatology/key402 for a patient with an acute gouty attack refractory to standard treatment.

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Abstract 17173: Association of Acute Gout Flares and Colchicine Use With Clinical Outcomes During Admission for Acute Decompensated Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.17173 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Melissa E Chinn ◽

Mary E Roth ◽

Steven P Dunn ◽

Kenneth C Bilchick ◽

Sula Mazimba

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Hospital Discharge ◽

Readmission Rate ◽

Acute Gout ◽

Significant Difference ◽

The Impact ◽

Gout Flare

Introduction: Gout is a common comorbidity in heart failure (HF) patients, and is often exacerbated by diuretic use. The impact of gout or the treatment of gout on HF outcomes is unknown. The purpose of this study was to assess clinical outcomes in patients being treated for an acute HF exacerbation and receiving colchicine for an acute gout flare. Methods: This was a single center, retrospective cohort study of patients treated for an acute HF exacerbation from March 2011 to February 2020. The gout group included patients receiving colchicine for an acute gout flare during admission. The control group included those who did not receive colchicine for an acute gout flare. The primary outcome was 30-day readmission rate. Secondary outcomes included in-hospital mortality and length of stay. Results: In the cohort of 1,047 patients (68.8 +/- 13.7 years, 38% female), 237 patients received colchicine for acute gout during admission. Length of stay was significantly greater (9.93 days vs. 7.96 days, p < 0.0001) and in-hospital mortality was significantly lower (2.2% vs. 6.6%, p = 0.009) in patients with versus without gout. In a multivariate logistic regression model, in-hospital colchicine given for a gout flare was significantly associated with reduced in-hospital mortality (OR 0.322, 95% CI 0.105-0.779, p = 0.02) after adjustment for home beta blocker use, inotrope use, age, and diabetes mellitus (p < 0.05 for all in the model). The association between colchicine and survival to hospital discharge was only observed in patients who received colchicine during the hospitalization, as opposed to home use only. There was no significant difference in 30-day readmission rate based on gout status for patients surviving to hospital discharge (21.5% vs. 19.5%, p = 0.495). Conclusions: Among patients with an acute HF exacerbation, patients treated for an acute gout flare with colchicine had a greater length of stay and lower in-hospital mortality compared with those not having gout. Future analyses are warranted to identify the relationship between colchicine use and HF outcomes.

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Upper Extremity Compartment Syndrome in a Patient with Acute Gout Attack but without Trauma or Other Typical Causes

Case Reports in Orthopedics ◽

10.1155/2018/3204714 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

John G. Skedros ◽

James S. Smith ◽

Marshall K. Henrie ◽

Ethan D. Finlinson ◽

Joel D. Trachtenberg

Keyword(s):

Compartment Syndrome ◽

Upper Extremity ◽

General Medicine ◽

Clinical History ◽

Acute Gout ◽

Exertional Compartment Syndrome ◽

Concurrent Infections ◽

History Of ◽

Multiple Symptoms ◽

Gout Flare

We report the case of a 30-year-old Polynesian male with a severe gout flare of multiple joints and simultaneous acute compartment syndrome (ACS) of his right forearm and hand without trauma or other typical causes. He had a long history of gout flares, but none were known to be associated with compartment syndrome. He also had concurrent infections in his right elbow joint and olecranon bursa. A few days prior to this episode of ACS, high pain and swelling occurred in his right upper extremity after a minimal workout with light weights. A similar episode occurred seven months prior and was attributed to a gout flare. Unlike past flares that resolved with colchicine and/or anti-inflammatory medications, his current upper extremity pain/swelling worsened and became severe. Hand and forearm fasciotomies were performed. Workup included general medicine, rheumatology and infectious disease consultations, myriad blood tests, and imaging studies including Doppler ultrasound and CT angiography. Additional clinical history suggested that he had previously unrecognized recurrent exertional compartment syndrome that led to the episode of ACS reported here. Chronic exertional compartment syndrome (CECS) presents a difficult diagnosis when presented with multiple symptoms concurrently. This case provides an example of one such diagnosis.

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High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study

Arthritis & Rheumatism ◽

10.1002/art.27327 ◽

2010 ◽

Vol 62 (4) ◽

pp. 1060-1068 ◽

Cited By ~ 267

Author(s):

Robert A. Terkeltaub ◽

Daniel E. Furst ◽

Katherine Bennett ◽

Karin A. Kook ◽

R. S. Crockett ◽

...

Keyword(s):

Acute Gout ◽

Double Blind ◽

Double Blind Placebo ◽

Dose Comparison ◽

Parallel Group ◽

Gout Flare

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ACUTE GOUT FLARE POST ST-ELEVATION MYOCARDIAL INFARCTION TREATED SUCCESSFULLY WITH ANAKINRA IN AN ELDERLY FEMALE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03910-3 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2555

Author(s):

Muhammad Asim Shabbir ◽

Muhammad Hamza Saad Shaukat ◽

Ruben Peredo-Wende ◽

Mikhail Torosoff

Keyword(s):

Myocardial Infarction ◽

St Elevation Myocardial Infarction ◽

Acute Gout ◽

Elderly Female ◽

St Elevation ◽

Gout Flare

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Effect of Clinical Typing on Serum Urate Targets of Benzbromarone in Chinese Gout Patients: A Prospective Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.806710 ◽

2022 ◽

Vol 8 ◽

Author(s):

Xiaomei Xue ◽

Xuan Yuan ◽

Lin Han ◽

Xinde Li ◽

Tony R. Merriman ◽

...

Keyword(s):

Serum Urate ◽

Chinese Patients ◽

Acute Gout ◽

Type Group ◽

Cholesterol Levels ◽

Chemical Indicators ◽

Serum Urate Level ◽

Secondary Endpoints ◽

Physical And Chemical ◽

Gout Flare

IntroductionAchieving a goal of serum urate levels in patients with gout is an important way to prevent gout and its complications while it remains difficult with a low targeting rate worldwidely. Currently, hyperuricemia classification has not been widely applied to the management of gout owing to insufficient clinical evidences. This study aimed to evaluate the effectiveness of achieving target urate based on hyperuricemia classification in Chinese patients with gout.MethodsIn this prospective study, patients with gout receiving urate lowering therapy with benzbromarone were assigned to two groups, a renal underexcretion and an unclassified type. The primary endpoint was the proportion of patients achieving the serum urate target (<360 μmol/L) during the 12-week study. The frequency of acute gout attacks as well as physical and chemical indicators were secondary endpoints.ResultsTarget serum urate level was achieved in 60.5% of underexcretors compared with 39.0% of patients of the unclassified type at week 12 (P = 0.002). Blood glucose and cholesterol levels were lower in the underexcretor group compared with the unclassified type group at the end of the trial, without significant different frequencies in gout flare during the study. In subgroup analysis, stratified by body mass index and estimated glomerular filtration rate, the proportion of patients with serum urate <360 μmol/L was greater in the underexcretion compared with the unclassified type group.ConclusionsThe increased achievement of target serum urate in the underexcretion group supports the use of a clinical hyperuricemia typing treatment strategy for gout.

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