allopurinol and Chondrocalcinosis

Monoarticular arthritis is inflammation characterized by joint pain, swelling, and sometimes periarticular erythema. Although chronic causes are seen, the onset is often acute. An infected joint can quickly lead to permanent damage, making it a medical emergency. However, acute gout presenting as monoarticular arthritis is often so uncomfortable it requires urgent attention. Monoarticular crystalline arthritis is common and a septic joint is a medical emergency so it is no surprise that these diagnoses come to mind with complaint of inflammation in 1 joint. However, there are many causes of monoarticular arthritis that clinicians must consider.

Topics: Adrenal Cortex Hormones; Arthritis; Arthritis, Infectious; Arthrocentesis; Chondrocalcinosis; Diagnosis, Differential; Gout; Injections, Intra-Articular; Synovitis; Uricosuric Agents; Xanthine Oxidase

Topics: Absorptiometry, Photon; Aged; Allopurinol; Arthritis, Gouty; Chondrocalcinosis; Cross-Sectional Studies; Enzymes, Immobilized; Evidence-Based Medicine; Febuxostat; Female; Gout Suppressants; Humans; Hyperuricemia; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Odds Ratio; Polyethylene Glycols; Risk Factors; Thiazoles; Ultrasonography; Urate Oxidase

Topics: Allopurinol; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Chondrocalcinosis; Comorbidity; Diabetes Mellitus, Type 2; Febuxostat; Gout; Gout Suppressants; Guideline Adherence; Humans; Hypertrophy, Left Ventricular; Hyperuricemia; Interleukin 1 Receptor Antagonist Protein; Kidney Failure, Chronic; Thiazoles; Xanthine Oxidase

Since the original recognition of these conditions in 1961, a great deal has been learned about the pathogenesis, clinical manifestations, and appropriate treatment of gout and pseudogout, and the role of crystals in osteoarthritis has been further defined. The variable manifestations of crystal-induced arthritis in elderly populations has led to a greater need for proper diagnosis and treatment strategies for these increasingly common forms of arthritis.

Topics: Aged; Allopurinol; Arthritis; Arthritis, Gouty; Calcium Pyrophosphate; Chondrocalcinosis; Comorbidity; Diagnosis, Differential; Glucocorticoids; Gout; Gout Suppressants; Humans; Hyperuricemia; Osteoarthritis; Renal Insufficiency; Uric Acid

In the acute stage of gout, the hallux is most commonly involved followed by the mediotarsal joints and the Achilles tendons. Diagnosis of gout is established when typical monosodium urate crystals can be identified. Apart from NSAIDs, colchicine can be used when there is no renal impairment. Hypouricemic agents (allopurinol or uricosuric drugs) must be initiated one or two weeks after the acute attack of gout because there are risks of exacerbation. Losartan as well as fenofibrate have uricosuric properties. Chondrocalcinosis of the foot can be observed in hemochromatosis. Diffuse idiopathic skeletal hyperostosis (DISH) can cause severe talagia. Hypercholesterolemia can induce xanthomas of the Achilles tendons. Apatite rheumatism can be observed in chronic dialysis patients.

Topics: Achilles Tendon; Acute Disease; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Apatites; Chondrocalcinosis; Colchicine; Fenofibrate; Foot Diseases; Gout; Gout Suppressants; Hallux; Hemochromatosis; Humans; Hypercholesterolemia; Hyperostosis, Diffuse Idiopathic Skeletal; Hypolipidemic Agents; Losartan; Radiography; Renal Dialysis; Time Factors; Xanthomatosis

Gout and calcium pyrophosphate deposition disease are two common causes of inflammatory joint disease. Despite differences underlying their pathogenesis, their clinical presentation and treatment share some common features. Optimal treatment for both requires prompt resolution of acute synovitis, reduction of chronic joint damage and management of associated conditions. Available therapeutic interventions and future strategies are reviewed in this article.

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Allopurinol; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Chondrocalcinosis; Colchicine; Drug Combinations; Enzyme Inhibitors; Febuxostat; Gout; Gout Suppressants; Humans; Multicenter Studies as Topic; Probenecid; Randomized Controlled Trials as Topic; Thiazoles; Uric Acid; Uricosuric Agents; Xanthine Oxidase

Topics: Allopurinol; Chondrocalcinosis; Colchicine; Diagnosis, Differential; Diet Therapy; Gout; Humans; Inosine Nucleotides; Joint Diseases; Metabolic Diseases; Orotic Acid; Purines; Urate Oxidase; Uric Acid; Uricosuric Agents

We report a case of calcium pyrophosphate dihydrate deposition disease (CPDD) involving a patient on maintenance hemodialysis (MHD). The 32-year-old man presented in August 2016 with a complaint of left shoulder swelling of 8 months' duration with no trauma or fever. He was diagnosed with nephrotic syndrome in 1998, which progressed to ESRD. He commenced MHD in 2012. Examination at our hospital revealed a soft nontender swelling of the left shoulder. Blood biochemistry showed elevated serum urate, phosphate, β2 microglobulin, and parathyroid hormone. Imaging revealed joint effusion and dense heterogenous deposition. Aspirate analysis showed urate crystals 3+, and culture yielded no growth. Following rheumatology review, the working diagnosis was periarticular tissue tuberculosis, after excluding pseudogout and amyloidosis. Following 1 month of colchicine and allopurinol, synovial fluid microscopy showed CPDD crystals. Symptoms gradually resolved over the course of 6 months. In this rare case, a diagnosis of CPDD was made with a multidisciplinary approach that included imaging and biochemical investigations.

Topics: Adult; Allopurinol; Bone Diseases, Metabolic; Chondrocalcinosis; Colchicine; Humans; Kidney Failure, Chronic; Male; Nephrotic Syndrome; Renal Dialysis; Vietnam

Topics: Adrenal Cortex Hormones; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthrocentesis; Chondrocalcinosis; Colchicine; Diet Therapy; Gout; Gout Suppressants; Humans; Injections, Intra-Articular; Microscopy, Polarization; Radiography; Synovial Fluid

Since the original descriptions of the involvement of crystals in arthritis, our understanding of the clinical syndromes of gout and pseudogout, and the role of basic calcium crystals in arthritis has increased. Gout is usually considered an affliction confined to middle-aged men, but has an increasing prevalence in older populations, with unique and often atypical features. Calcium pyrophosphate dihydrate crystal deposition disease is common in elderly patients. The diagnosis of both of these common forms of arthritis and the need to individualize therapy in patients with other medical problems remain important clinical challenges to the practicing physician.

Topics: Aged; Allopurinol; Chondrocalcinosis; Fingers; Gout; Gout Suppressants; Humans; Hyperuricemia; Radiography

Of 9,108 consecutive new patients seen in an outpatient rheumatology clinic, 155 (1.7%) were diagnosed as having gout. But 164 (1.8%) had been incorrectly diagnosed as having gout in the community. Misdiagnosis was more likely in those with psoriatic arthritis (odds ratio 3.841, 1.944-7.590) and pseudogout (odds ratio 4.152, 2.422-7.119) and less common in patients with nonspecific arthralgias (odds ratio 0.536, 0.326-0.881). Seventy-six percent of incorrectly diagnosed patients received allopurinol while slightly more than 15% were treated with uricosuric agents.

Topics: Adult; Aged; Allopurinol; Analysis of Variance; Arthritis, Psoriatic; Chondrocalcinosis; Colchicine; Databases, Factual; Diagnostic Errors; Female; Gout; Humans; Male; Middle Aged; Prevalence; Probenecid; Prospective Studies; Uremia

Topics: Allopurinol; Arthritis, Rheumatoid; Chondrocalcinosis; Colchicine; Diagnosis, Differential; Gout; Humans; Long-Term Care; Oxyphenbutazone; Phenylbutazone; Uric Acid

Topics: Allopurinol; Arthritis; Calcium Phosphates; Cartilage, Articular; Chondrocalcinosis; Crystallization; Diphosphates; Gout; Humans; Kidney Diseases; Kidney Tubules; Leukocytes; Macrophages; Myeloproliferative Disorders; Synovial Fluid; Uric Acid