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Aparisi Gómez MP, Boitsios G, Rosaria Petrera M, Guglielmi G, Simoni P, Bazzocchi A. How to Approach the Imaging Differential Diagnosis of Rheumatic Diseases by Anatomic Location. Radiol Clin North Am 2024; 62:755-782. [PMID: 39059970 DOI: 10.1016/j.rcl.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The purpose of this review is to present an approach to differential diagnosis based on the particular features of involvement of the most common rheumatological conditions focused on anatomic location (by joint). The most common radiological signs and how they are demonstrated in different modalities, as well as the typical patterns of involvement are analyzed, with the aim to facilitate the differential diagnosis. Early and adequate adjustment of treatment has an effect on outcome, and on this basis, early diagnosis and characterization are paramount to appropiately manage patients.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Anatomy and Medical Imaging, Waipapa Taumata Rau, University of Auckland, Building 501-002, 85 Park Road, Grafton, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, València 46024, Spain.
| | | | - Miriana Rosaria Petrera
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale Pinto 1, 71122 Foggia, Italy; Radiology Unit, "Dimiccoli" Hospital, Viale Ippocrate 15, 76121 Barletta, Italy; Department of Radiology, Hospital IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy
| | - Paolo Simoni
- Rheumatology Department, Centre Hospitalier Universitaire de Liège, Avenue de l'Hopital, 1, Liège 4000, Belgium
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
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Kirschenbaum JD, Patel RG, Boylan MR, Virk MS. Operative Management of Gouty Tophi in the Region of the Olecranon: A Case Series. JSES Int 2022; 6:550-554. [PMID: 35572418 PMCID: PMC9091931 DOI: 10.1016/j.jseint.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Tophaceous gout affecting the olecranon region can result in local discomfort, skin ulceration, secondary infection, and considerable disability if left untreated. However, there are limited reports of outcomes, including postoperative complications and recurrence after surgical excision of tophaceous gout deposits at the elbow. The aim of this study is to present our surgical technique and minimum one-year outcomes after surgical excision of tophaceous gout involving the elbow. Methods A retrospective chart review was performed on all patients from a single surgeon's practice who underwent surgical excision of gouty tophi of the elbow between January 2016 and December 2019. The indications for surgical excision of tophi included failure of medical management, presence of skin ulceration, and/or large gouty tophi. The relevant data pertaining to patient demographics, preoperative findings, intraoperative findings, surgical pathology reports, and short-term postoperative complications were collected through retrospective chart review. Patients were subsequently contacted for a follow-up telehealth visit to assess recurrence of gouty tophi, functional outcomes, and range of motion (ROM) measurements. Results Six male patients underwent 7 total procedures (1 bilateral elbow) during the study period. The mean age of the cohort at the time of surgery was 56.0 ± 7.1 years (range: 45.3-63.5). The mean size of the swelling in 2 maximum dimensions was 5.8 × 3.4 cm. There were no intraoperative or immediate postoperative wound complications. There was no recurrence of gouty tophi at a mean follow-up time of 30.8 months (range: 14.0-43.5). Patients reported physiologic ROM (mean flexion-extension arc of 2°-134°) with no pain at final follow-up. Conclusion Surgical treatment of tophaceous gout of the elbow is associated with a low risk of wound complication and recurrence.
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Affiliation(s)
| | | | | | - Mandeep S. Virk
- Corresponding author: Mandeep S. Virk, MD, 246 East 20th Street, New York, NY 10003, USA.
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Zhong Z, Huang Y, Huang Q, Zheng S, Huang Z, Deng W, Li T. Serum metabolic profiling analysis of gout patients based on UPLC-Q-TOF/MS. Clin Chim Acta 2021; 515:52-60. [PMID: 33388309 DOI: 10.1016/j.cca.2020.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/06/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gout is a common kind of inflammatory arthritis with metabolic disorders. However, the detailed pathogenesis of gout is complex and not fully clear. We investigated the serum metabolic profiling of gout patients by ultra-performance liquid chromatograph quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS). METHODS Serum metabolites were extracted from 31 gout patients and 31 healthy controls. Metabolite extracts were analyzed in negative mode by UPLC-Q-TOF/MS for global metabolomics. Principal components analysis (PCA), orthogonal partial least squares-discriminant analysis (OPLS-DA) and hierarchical clustering analysis were performed to detect different compounds between the two groups. Receiver operating characteristic (ROC) curve analysis and pathway analysis of the different metabolites were conducted. RESULTS A total of 9192 compounds were detected, of which 138 significantly different compounds were selected, according to the criteria of (Variable importance in projection (VIP) > 3). Hierarchical clustering analysis showed that the relative levels of the differential compounds were different between the 2 groups. Ninety-one reliable metabolites matching the human metabolome database (HMDB) were confirmed. ROC curve results revealed that 4-hydroxytriazolam, urate and bilirubin exerted higher AUC values. Pathway analysis indicated that the significantly different metabolites were mainly involved in primary bile acid biosynthesis, purine metabolism and glycerophospholipid metabolism. CONCLUSIONS The serum metabolic profiling of gout patients was significantly different from healthy subjects based on UPLC-Q-TOF/MS. Bilirubin was the potential biomarker. Primary bile acid biosynthesis may be a novel metabolic pathway of gout.
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Affiliation(s)
- Zheng Zhong
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Yukai Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Qidang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Shaoling Zheng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Zhixiang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Weiming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Tianwang Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China.
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Sumiyoshi R, Koga T, Tsuji S, Endo Y, Takatani A, Shimizu T, Igawa T, Umeda M, Fukui S, Nishino A, Kawashiri SY, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Kawakami A. Chlamydia-induced reactive arthritis diagnosed during gout flares: A case report and cumulative effect of inflammatory cytokines on chronic arthritis. Medicine (Baltimore) 2019; 98:e17233. [PMID: 31577714 PMCID: PMC6783181 DOI: 10.1097/md.0000000000017233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
RATIONALE The pathology of gouty arthritis and reactive arthritis (ReA) partially overlaps, and both diseases are characterized by the production of inflammatory cytokines associated with the activation of monocytes and macrophages. However, the precise cytokine profile of cases with a coexistence of both diseases is unknown, and there are few reports on the course of treatment in patients with both gouty arthritis and ReA. PATIENT CONCERNS A 39-year-old man with a recurrent episode of gouty arthritis presented prednisolone-resistant polyarthritis with high level of C-reactive protein (CRP). He had the features of gouty arthritis such as active synovitis of the first manifestation of metatarsophalangeal (MTP) joints and the presence of monosodium urate (MSU) crystals from synovial fluid. But he also had the features of ReA such as the presence of tenosynovitis in the upper limb, the positivity of human leukocyte antigen (HLA)-B27, a history of sexual contact and positive findings of anti-Chlamydia trachomatis-specific IgA and IgG serum antibodies. DIAGNOSES He was diagnosed with HLA-B27 associated Chlamydia-induced ReA accompanied by gout flares. INTERVENTIONS He was treated with 180 mg/day of loxoprofen, 1 mg/day of colchicine, and 10 mg/day of prednisolone for gout flares. However, his polyarthritis worsened with an increased level of CRP (23.16 mg/dL). Accordingly, we added 500 mg/day of salazosulfapyridine followed by adalimumab (ADA) 40 mg once every 2 weeks. OUTCOMES After starting ADA, the patient's symptoms and laboratory findings showed rapid improvement and he achieved clinical remission 1 month after initiation of ADA treatment. As of this writing, the patient's clinical remission has been maintained for >1 year. LESSONS This case suggests that with exacerbation of arthritis during gouty arthritis, coexistence with other pathologies such as peripheral spondyloarthritis should be considered, and early intensive treatment including tumor necrosis factor inhibitors may be necessary.
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Affiliation(s)
- Remi Sumiyoshi
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Tomohiro Koga
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
- Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Sosuke Tsuji
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Yushiro Endo
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Ayuko Takatani
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Toshimasa Shimizu
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Takashi Igawa
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Masataka Umeda
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
- Medical Education Development Center, Nagasaki University Hospital
| | - Shoichi Fukui
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Ayako Nishino
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
- Center for Comprehensive Community Care Education
| | - Shin-ya Kawashiri
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
- Department of Community Medicine, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoki Iwamoto
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Kunihiro Ichinose
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Mami Tamai
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Hideki Nakamura
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Tomoki Origuchi
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
| | - Atsushi Kawakami
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology
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Diagnostic accuracy of dual-energy CT and ultrasound in gouty arthritis : A systematic review. Z Rheumatol 2019; 76:723-729. [PMID: 28058498 DOI: 10.1007/s00393-016-0250-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of our study was to compare the overall accuracy of ultrasonography (US), with at least one sign positive (double contour, tophus, aggregates), and dual-energy CT in the diagnosis of gouty arthritis. METHODS PubMed, Web of Science, EI, Elsevier, Wiley Online Library and Cochrane library were systematically searched for studies on the diagnostic performance of dual-energy CT (DECT) and ultrasound (US) from 2005 to February 2016. After study selection, data and quality assessment, the sensitivity (SEN), specificity (SPE), diagnostic odds rate (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and summary receiver operating contraction racteristic (SROC) curves were calculated. RESULTS Eleven publications met our inclusion criteria. Of these, six studies were included in the dual-energy CT group, six studies in the US group, and one study compared dual-energy CT and US. The pooled SEN, SPE, DOR, PLR, NLR and SROC of US with at least one sign positive, were 93%, 73%, 37.94, 3.39, 0.11 and 92%, respectively; and of DECT the values were 88%, 85%, 38.70, 5.12, 0.16, 93% and respectively. CONCLUSION Based on current evidence, both US and DECT can be used for diagnosis of gouty arthritis, but there are some differences between them regarding diagnostic sensitivity and specificity.
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Engel B, Just J, Bleckwenn M, Weckbecker K. Treatment Options for Gout. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:215-222. [PMID: 28434436 DOI: 10.3238/arztebl.2017.0215] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 07/21/2016] [Accepted: 12/29/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND 1-2% of adults in Germany suffer from gout. Gout is one of the few rheumatological diseases that can be cured. It arises through the deposition of uric acid crystals in joints as a result of hyperuricemia. Painful redness and swelling of the affected joints are typical findings. Multiple pertinent guidelines and treatment recommendations have been published, but there is reason to believe that patients with gout are not always treated accordingly. METHODS This review is based on relevant publications from the years 2000-2016 that were retrieved by a selective search in the Cochrane and PubMed databases. RESULTS In a person with normal renal function, asymptomatic hyperuricemia is not an indication for treatment to lower the serum uric acid level. The drugs of first choice for acute gouty arthritis are nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and colchicine. Treatment with xanthine oxidase inhibitors (XOI) or uricosuric drugs is indicated for patients with a recurrent or severe course; the target uric acid value is <6 mg/dL. Long-term treatment should be initiated only after resolution of the acute attack. For patients with refractory gout, lesinurad (approved in February 2016) in combination with XOI is a new treatment option that can be considered. Comprehensive patient education and counseling is an important component of the treatment of patients with gout. Regular laboratory follow-up is necessary as well. CONCLUSION The prevalence of gout is rising around the world. Patients with gout could benefit greatly from consistent implementation of the existing treatment guidelines and recommendations. In the future, controlled trials should be conducted to determine the best time to start treatment and the optimal target level for the serum uric acid concentration in terms of a risk/benefit analysis.
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Affiliation(s)
- Bettina Engel
- Institute of General Practice and Family Medicine, University Hospital Bonn
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Aslam F, Michet C. My Treatment Approach to Gout. Mayo Clin Proc 2017; 92:1234-1247. [PMID: 28778257 DOI: 10.1016/j.mayocp.2017.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/27/2022]
Abstract
Gout is the most common form of inflammatory arthritis in the United States. Nevertheless, gout remains misunderstood, misdiagnosed, underdiagnosed, and undertreated. Several new recommendation and guideline documents regarding the management of gout have been published in the past few years. New diagnostic modalities, such as ultrasound and dual-energy computed tomography, are now available. Newer treatment options exist, and older agents and their interactions are now better understood. This review addresses these recent diagnostic and therapeutic developments and describes our management protocol with the aim of providing the clinician with a pragmatic approach to gout management.
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Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ
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