MyMedR

Fulltext Acute gout in hospitalized patients in Sarawak General Hospital

Teh CL, Chew KF, Ling GR

Med J Malaysia, 2014 Jun;69(3):126-8.

We performed a prospective study of all hospitalized patients with a diagnosis of Gout in Sarawak General hospital from 1st July 2011 to 1st July 2012. There were a total of 126 patients in our study of which 112 (88.9%) were males. The majority of our patients were from the indigenous populations (71.7%). They have a mean age of 60.0 ± 14.2 years. Most of our patients were overweight (68%) with comorbities of hypertension (78.6%), Chronic Kidney Failure (48.4%), Type II diabetes Mellitus (30.2%), dyslipidemia (27.8%) and Ischaemic heart disease (11.9%). Polyarticular gouty arthritis was the main presenting pattern during hospitalization (88.1%). The mean length of stay for our patients was 9.8 ± 6.0 days which was significantly longer than the mean length of stay for other patients without gout (p<0.05). Only 17 patients had gout on admission and the majority developed gout during hospitalizations. Our patients were admitted respectively for medical problems (45.4%), surgical problems (28.6%) and orthopaedic problems (9.2%). Colchicine (73.8%) and steroid (40.5%) were the main stays of treatment for our patients. Our hospitalized gout patients were complicated patients with multiple comorbidities.

Matched MeSH terms: Arthritis, Gouty; Arthritis, Gouty*

Fulltext In vivo detection of monosodium urate crystal deposits by Raman spectroscopy-a pilot study

Abhishek A, Curran DJ, Bilwani F, Jones AC, Towler MR, Doherty M

Rheumatology (Oxford), 2016 Feb;55(2):379-80.

PMID: 26342227 DOI: 10.1093/rheumatology/kev339

Study done in England

Matched MeSH terms: Arthritis, Gouty/diagnosis; Arthritis, Gouty/metabolism*

Fulltext Anti-gout potential of Malaysian medicinal plants

Abu Bakar FI, Abu Bakar MF, Rahmat A, Abdullah N, Sabran SF, Endrini S

Front Pharmacol, 2018;9:261.

PMID: 29628890 DOI: 10.3389/fphar.2018.00261

Gout is a type of arthritis that causes painful inflammation in one or more joints. In gout, elevation of uric acid in the blood triggers the formation of crystals, causing joint pain. Malaysia is a mega-biodiversity country that is rich in medicinal plants species. Therefore, its flora might offer promising therapies for gout. This article aims to systematically review the anti-gout potential of Malaysian medicinal plants. Articles on gout published from 2000 to 2017 were identified using PubMed, Scopus, ScienceDirect, and Google Scholar with the following keyword search terms: "gout," "medicinal plants," "Malaysia," "epidemiology," "in vitro," and "in vivo." In this study, 85 plants were identified as possessing anti-gout activity. These plants had higher percentages of xanthine oxidase inhibitory activity (>85%); specifically, the Momordica charantia, Chrysanthemum indicum, Cinnamomum cassia, Kaempferia galanga, Artemisia vulgaris, and Morinda elliptica had the highest values, due to their diverse natural bioactive compounds, which include flavonoids, phenolics, tannin, coumarins, luteolin, and apigenin. This review summarizes the anti-gout potential of Malaysian medicinal plants but the mechanisms, active compounds, pharmacokinetics, bioavailability, and safety of the plants still remain to be elucidated.

Matched MeSH terms: Arthritis, Gouty

Fulltext Compensated polarised microscopy: a simple and cheap modification

Veerapen K, Ch'ng SL

Med J Malaysia, 1987 Sep;42(3):217-8.

PMID: 3509837

Matched MeSH terms: Arthritis, Gouty/diagnosis

Fulltext A case of gout

Monteiro ES

Journal of the Malaya Branch of the British Medical Association, 1937;1(1):73-5.

Matched MeSH terms: Arthritis, Gouty

Fulltext Gouty wrist arthritis causing carpal tunnel syndrome--a case report

Sikkandar MF, Sapuan J, Singh R, Abdullah S

Med J Malaysia, 2012 Jun;67(3):333-4.

PMID: 23082430

A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.

Matched MeSH terms: Arthritis, Gouty/complications*; Arthritis, Gouty/radiography

Fulltext Tophaceous gout causing atlanto-axial subluxation mimicking rheumatoid arthritis: a case report

Wazir NN, Moorthy V, Amalourde A, Lim HH

J Orthop Surg (Hong Kong), 2005 Aug;13(2):203-6.

PMID: 16131689 DOI: 10.1177/230949900501300220

This is a case report of an extremely rare condition of atlanto-axial subluxation secondary to gouty arthritis, which mimicked rheumatoid arthritis at presentation. Gouty arthritis involving the spine is a rare condition. We highlight a case of gouty arthritis involving the atlanto-axial joint resulting in joint instability, subluxation, and neurological deficit. A 66-year-old obese woman who had a polyarticular disease for the previous 3 years presented with neck pain and progressive neurology. A 2-stage procedure was performed: posterior decompression and occipitocervical fusion followed by further anterior trans-oral decompression. However, after an initial neurological improvement, she succumbed to aspirational pneumonia and septicaemia. Atlanto-axial subluxation caused by gouty arthritis can present in the same way as rheumatoid arthritis. Therefore, the possibility of this as a differential diagnosis should be kept in mind.

Matched MeSH terms: Arthritis, Gouty/complications*; Arthritis, Gouty/diagnosis*

Fulltext Vertebrae Destruction with Cauda Equina Syndrome Secondary to Spinal Gouty Arthritis: A Case Report

Thuraikumar K, Wan KL, Ong KL, Lim SW

Malays Orthop J, 2020 Jul;14(2):141-144.

PMID: 32983391 DOI: 10.5704/MOJ.2007.024

Gouty arthritis commonly affects peripheral joints and is associated with hyperuricaemia. Spinal manifestations of gouty arthritis are not common, and majority of published articles worldwide were case reports. This is a case report of spinal gouty arthritis that presented with spinal vertebrae destruction and cauda equina syndrome. The magnetic resonance imaging (MRI) showed destruction of L5/S1end plates with cystic collection mimicking infective changes. The tissue histological examination confirmed presence of urate crystal needles that displayed negative double refraction on light microscopy. Spinal gouty arthritis is part of the differential diagnoses in gouty arthritis patients.

Matched MeSH terms: Arthritis, Gouty

Fulltext A rare presentation of isolated carpal bone tuberculous osteomyelitis mimicking gouty arthritis

Abdul Hamid MF, Rajandiran SR, Yu-Lin AB, Sapuan J

Int J Mycobacteriol, 2020 8 31;9(3):325-328.

PMID: 32862171 DOI: 10.4103/ijmy.ijmy_97_20

Tuberculosis (TB) is the most prevalent infectious disease in Southeast Asia. It causes both pulmonary and extrapulmonary diseases. TB of the wrist is rare and presents as osteomyelitis or tenosynovitis. We report a middle-aged male with carpal bone tuberculous osteomyelitis. He presented with left wrist pain initially treated as gouty arthritis. Within 2 weeks, he developed seropurulent discharge with osteomyelitic changes on imaging. He underwent debridement, and intraoperatively, there was destruction of most carpal bones. Histopathological examination revealed chronic granulomatous inflammation with abscess formation. Anti-TB medication was initiated, and he made a complete recovery with almost full range of wrist movement after 9 months of treatment. This case serves as a reminder that TB is a great mimicker, and a high index of suspicion is required to make a diagnosis of TB of the wrist. Early initiation of anti-TB is pivotal to prevent complications and deterioration of joint functions.

Matched MeSH terms: Arthritis, Gouty/pathology*

Fulltext Older age and diclofenac are associated with increased risk of upper gastrointestinal bleeding in gout patients

Wan Ghazali WS, Wan Zainudin WMKB, Yahya NK, Mohamed Ismail A, Wong KK

PeerJ, 2021;9:e11468.

PMID: 34055491 DOI: 10.7717/peerj.11468

Background: Gouty arthritis is a disease of global burden in which defective metabolism of uric acid causes arthritis. Gouty arthritis or medications used for its treatment may lead to uric acid-associated complications such as upper gastrointestinal bleeding (UGIB) and renal impairment.

Methods: In this cross-sectional study with retrospective record review, 403 established gouty arthritis patients were recruited to determine the incidence of UGIB and associated factors among gout patients who were on regular nonsteroidal anti-inflammatory drugs (NSAIDs).

Results: The mean age of the 403 gouty arthritis patients was 55.7 years old and the majority (n = 359/403; 89.1%) were male. The incidence of UGIB among gouty arthritis patients who were on NSAIDs was 7.2% (n = 29/403). Older age (p < 0.001), diclofenac medication (p = 0.003), pantoprazole medication (p = 0.003), end-stage renal failure (ESRF) (p = 0.007), smoking (p = 0.035), hypertension (p = 0.042) and creatinine (p = 0.045) were significant risk factors for UGIB among the gouty arthritis patients in univariable analysis. Older age (p = 0.001) and diclofenac medication (p < 0.001) remained significant risk factors for UGIB among the gouty arthritis patients in multivariable analysis.

Conclusions: Age and diclofenac were significantly associated with UGIB among patients with gouty arthritis on regular NSAIDs, indicating that these factors increased the risks of developing UGIB in gout patients. Hence, these high-risk groups of gouty arthritis patients should be routinely monitored to avoid the potential onset of UGIB. Our data also suggest that diclofenac should be prescribed for the shortest duration possible to minimize the risk of developing UGIB in gout patients.

Matched MeSH terms: Arthritis, Gouty

Association of solute carrier family 2, member 9 (SLC2A9) genetic variant rs3733591 with gout in a Malay sample set

Wan Rohani WT, Mahfudzah A, Nazihah MY, Tan HL, Wan Syamimee WG, Amanda Jane PG, et al.

Med J Malaysia, 2018 10;73(5):307-310.

PMID: 30350810 MyJurnal

INTRODUCTION: Gout is one of the most common inflammatory arthritis in Malaysia. It is due to persistent hyperuricemia that leads to the formation and deposition of intra- and periarticular monosodium urate crystals either due to excessive production or insufficient excretion of uric acid. Incidence and prevalence of gout is increasing worldwide, with a higher rate among men compared to women. Malay is the largest ethnic group in Malaysia, followed by Chinese and Indian. SLC2A9 is a renal urate transporter that controls renal uric acid excretion and genetic variants in SLC2A9 are associated with the risk of gout in several populations. This study aimed to test if the SLC2A9 variant (R265H, rs3733591) is also associated with gout among Malays in Malaysia.

METHODOLOGY: A total of 89 patients with gouty arthritis and 100 normal subjects who consented and were recruited in this study. The serum urate and creatinine were measured. The SNP genotyping was performed using PCR-RFLP method for rs3733591 and BST 1236 was used as a restriction enzyme to cut the targeted amplicons.

RESULT: SLC2A9 variant was associated with gout, p-value of 0.007, OR=4.713 [95%CI 1.530-14.513], however this association was not significant after adjustment for age and gender with p=0.465 (OR=1.950; 95%CI[0.325-11.718]).

CONCLUSION: Our data suggest that the genetic variant of SLC2A9 may contribute to the susceptibility of gout among Malays in Malaysia.

Matched MeSH terms: Arthritis, Gouty

Fulltext Septic arthritis in rheumatology: review of five cases

Muhayidina AD, Said MS

J Clin Med Res, 2009 Aug;1(3):173-7.

PMID: 22493652 DOI: 10.4021/jocmr2009.08.1254

This report illustrates five cases of patients admitted to medical ward in HUKM, diagnosed and treated as septic arthritis over the course of two months. Their age ranged from 32 to 67 years old with one patient had history of monoarticular pain and the other four had polyarticular pain. Two of these patients had pre-existing joint disease, namely gouty arthritis and rheumatoid arthritis, and another patient with background history of mixed connective tissue disease on long term steroid therapy. The diagnosis of septic arthritis was made mainly from clinical assessment, supported by synovial fluid assessment and blood investigations. All patients received minimum of two weeks intravenous antibiotic followed by one month course of antibiotic. All of them had arthrocentesis for diagnostic and therapeutic purposes and two had laparoscopic arthroscopy with wash out done.

Matched MeSH terms: Arthritis, Gouty

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