Diagnosis and Treatment of Gout Arthritis

Gout is a heterogeneous, often familial, metabolic disease associated with abnormal deposits of uric acid in tissues and initially characterized by recurrent acute arthritis, usually monoarticular, and later by chronic deforming arthritis. Urate deposition occurs when serum uric acid is saturated (that is, at greater than 6.8 mg/dL [404.5 mcmol/L]). Hyperuricemia is caused by excess or underexcretion of uric acid, sometimes both. The disease is especially common in the Pacific islands, for example, the Philippines and Samoa. Acute gouty arthritis is sudden in onset and often occurs at night. It may develop without a clear precipitating cause or may follow a rapid increase or decrease in serum urate levels. Common precipitants are excess alcohol (especially beer), changes in medications that affect urate metabolism, and, in hospitalized patients, fasting before medical procedures. This literature review presents gout arthritis, symptoms and signs in general to the prognosis of this disease.

Efficacy And Renal Safety of Febuxostat In Management of Gout And Chronic Kidney Disease: A Retrospective Study

Background: Elevated serum urate levels are associated with renal deterioration of chronic kidney disease (CKD). Whether urate-lowering treatment with febuxostat can improve renal function or attenuate the decline of the estimated glomerular filtration rate (eGFR) is controversial. The current study sought to explore efficacy and renal safety of febuxostat in gout patients with CKD and explore factors correlated with target serum urate (sUA).Methods: The current study was a single-center retrospective study comprising male gout patients with CKD. sUA, the rate of sUA < 360 µmol/L and renal safety were analyzed in subjects who had been treated with febuxostat for more than 44 weeks. Factors correlated with target sUA were explored by logistic regression analysis. Results: A total of 87 patients who had been diagnosed with gout and CKD met the inclusion criteria for the study. Twenty-five (28.73%) patients presented with stage 2 CKD, 58 (66.67%) were diagnosed with stage 3 CKD and 4 (4.60%) were diagnosed with stage 4 CKD. Analysis of sUA level showed a significant reduction at week 44~ (598.22 ± 95.11 µmol/L vs. 429.76 ± 123.45 μmol/L; P < 0.05), and the RAT increased to 34.50%. eGFR level of all patients was 52.37 ± 11.74 ml/min/1.73cm2 at baseline and 56.51 ± 15.01 ml/min/1.73cm2 at week 44~ (P < 0.05). The findings showed improvement of eGFR level in different stages of CKD, mainly in stage 3 CKD patients (P < 0.05). After stratification based on risk factors of hypertension, diabetic mellitus, hyperlipidemia and the usage of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), the findings showed that eGFR levels of patients with ≤ 1 risk factors showed significant improvement (P < 0.05). Logistic regression analysis indicated that baseline sUA level and acute arthritis were correlated with the RAT in gout and CKD patients treated with febuxostat.Conclusions: In this retrospective study, febuxostat demonstrated effective and renal safety in gout patients with CKD. Baseline sUA level and acute arthritis may affect achieving of target sUA.

Seasonality of Acute Lyme Disease in Children

Due to the life cycle of its vector, Lyme disease has known seasonal variation. However, investigations focused on children have been limited. Our objective was to evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States. We enrolled children presenting to one of eight Pedi Lyme Net participating emergency departments. Cases were classified based on presenting symptoms: early (single erythema migrans (EM) lesion), early-disseminated (multiple EM lesions, headache, cranial neuropathy, or carditis), or late (arthritis). We defined a case of Lyme disease by the presence of an EM lesion or a positive two-tier Lyme disease serology. To measure seasonal variability, we estimated Fourier regression models to capture cyclical patterns in Lyme disease incidence. While most children with early or early-disseminated Lyme disease presented during the summer months, children with Lyme arthritis presented throughout the year. Clinicians should consider Lyme disease when evaluating children with acute arthritis throughout the year.

Atypical Presentation of Haemophilus influenzae Septic Arthritis: A Case Report

Introduction: Septic arthritis is a destructive form of acute arthritis that requires expeditious recognition. as delayed treatment yields significant morbidity and mortality. Case Report: A 40-year-old male presented to the emergency department with right elbow pain. Examination revealed tachycardia, swelling, redness, tenderness, and decreased range of motion of the right humeroulnar joint. Synovial fluid analysis was consistent with an inflammatory etiology, but blood and joint cultures ultimately revealed Haemophilus influenzae. Discussion: This case highlights the importance of trusting clinical findings over laboratory evidence in patients with suspected septic arthritis.

Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?

The term septic arthritis refers to an infection of the synovial space. This is an infrequent condition in healthy children, but it should be considered a medical emergency potentially leading to irreversible articular damage. Therefore, prompt diagnosis and antimicrobial treatment play a crucial role in improving the prognosis. Although septic arthritis is the most common cause of acute arthritis, many other diseases may mimic a similar clinical picture, constituting a diagnostic challenge for the clinician who first approaches the patient. Herein we analyze the main features of septic arthritis, offering an overview of the main conditions involved in the differential diagnosis and suggesting a diagnostic workup plan.

A Mouse Model for Studying Post-Acute Arthritis of Chikungunya

Chikungunya virus (CHIKV) was introduced to the Americas in 2013, causing two million infections across over thirty countries. CHIKV causes a chronic debilitating arthritis in one fourth of infected individuals and currently evidence-based targeted therapies for the treatment of CHIKV arthritis are lacking. Multiple mouse models of chikungunya have been developed to study acute CHIKV infection. In humans, post-CHIKV arthritis may persist for months to years after viremia from a CHIKV infection has resolved. Therefore, the development of a mouse model of post-acute arthritis of chikungunya may facilitate the study of potential novel therapeutics for this arthritis. In this article we describe the development of a wild-type immunocompetent C57BL/6 mouse model for post-acute arthritis of chikungunya, including a histologic inflammation scoring system, as well as suggestions for how this mouse model may be used to examine the efficacy of novel therapies for CHIKV arthritis.