Disseminated cutaneous gout: a rare manifestation of a common disease

Disseminated cutaneous gout is a rare atypical cutaneous manifestation of gout in which widespread dermal and subcutaneous tophi develop at extra-articular body sites. Given the lack of joint involvement that is typically a feature in tophaceous gout, the diagnosis may not be initially suspected. We present the case of a 50-year-old Hispanic man with poorly controlled gout who was evaluated for several years of firm papulonodules over the trunk and upper and lower extremities, sparing the joints; histopathology confirmed, the diagnosis of disseminated cutaneous gout. Per our literature review, disseminated cutaneous gout presents with polymorphous papules and nodules that can mimic other, more common cutaneous diseases. There is a preponderance of cases in males, Asians, and patients with longstanding gout. The lower extremities are involved in nearly all reports. Uric acid-lowering therapy with allopurinol has been reported to decrease the size and number of lesions in a minority of treated patients

Gout

INTRODUCTION: Gout affects about 5% of men and 1% of women, with up to 80% of people experiencing a recurrent attack within 3 years. METHODS AND OUTCOMES:We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute gout? What are the effects of treatments to prevent gout in people with prior acute episodes? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria.We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: colchicine, corticosteroids, corticotrophin (ACTH), non-steroidal anti-inflammatory drugs (NSAIDs), sulfinpyrazone, xanthine oxidase inhibitors, advice to lose weight, advice to reduce alcohol intake, advice to reduce dietary intake of purines

Purine-Rich Foods Intake and Recurrent Gout Attacks

OBJECTIVE: To examine and quantify the relation between purine intake and the risk of recurrent gout attacks among gout patients. METHODS: The authors conducted a case-crossover study to examine associations of a set of putative risk factors with recurrent gout attacks. Individuals with gout were prospectively recruited and followed online for 1 year. Participants were asked about the following information when experiencing a gout attack: the onset date of the gout attack, clinical symptoms and signs, medications (including antigout medications), and presence of potential risk factors (including daily intake of various purine-containing food items) during the 2-day period prior to the gout attack. The same exposure information was also assessed over 2-day control periods. RESULTS: This study included 633 participants with gout. Compared with the lowest quintile of total purine intake over a 2-day period, OR of recurrent gout attacks were 1.17, 1.38, 2.21 and 4.76, respectively, with each increasing quintile (p for trend <0.001). The corresponding OR were 1.42, 1.34, 1.77 and 2.41 for increasing quintiles of purine intake from animal sources (p for trend <0.001), and 1.12, 0.99, 1.32 and 1.39 from plant sources (p=0.04), respectively. The effect of purine intake persisted across subgroups by sex, use of alcohol, diuretics, allopurinol, NSAIDs and colchicine. CONCLUSIONS: The study findings suggest that acute purine intake increases the risk of recurrent gout attacks by almost fivefold among gout patients. Avoiding or reducing amount of purine-rich foods intake, especially of animal origin, may help reduce the risk of gout attacks

GOUT ARTHRITIS DISTAL DIBULA MIMICKING BONE TUMOR: A CASE REPORT

Gout is a picturesque presentation of uric acid disturbance. The clinical picture of gout is divided into asymptomatic hyperuricemia, acute gouty arthritis, intercritical period, and chronic tophaceous gout. The tophus found on gouty arthritis has clinical resemblance to neoplastic lesions such as epidermoid cysts therefore it is often mistaken. Diagnosis of gout is based on the history, the laboratory result, ultrasonography and histopathological examination. Management of gout includes management of flares, chronic gout, as well as management of comorbidities. Keywords: Gout arthritis, distal fibula, tophus, bone tumou

Masalah Utama Gout ( Asam Urat ) Khususnya pada Tn. S di Wilayah Kerja Puskesmas Gatak

Latar Belakang : Banyak orang membicarakan penyakit gout (asam urat). Penyakit ini populer di kalangan masyarakat luas, sayang pemahaman paa penyakit ini sangat terbatas serta banyak orang salah memahami penyakit gout secara benar. Tujuan : Untuk mengetahui asuhan keperawatan keluarga pada pasien dengan gout (asam urat) yang meliputi pengkajian, penentuan diagnosa, perencanaan asuhan keperawatan, pelaksanaan asuhan keperawatan dan evaluasi. Hasil : Setelah di lakukan asuhan keperawatan selama 1 minggu 3x kunjungan keluarga mengetahui apa it gout, penyebab, tanda dan gejala serta komplikasi gout, mampu mengetahui apa penyebab dari nyeri pada pasien gout dan mampu merawat keluarga yang menderita gout dan pasien mampu melakukan ROM secara mandiri. Kesimpulan : Peran aktif keluarga sangat di perlukan dalam pelaksanaan asuhan keperawatan keluarga karena keluarga lah yang secara berkesinambungan melihat kaedaan pasien

PENGELOLAAN KEPERAWATAN NYERI PADA LANSIA DENGAN ARTHRITIS GOUT DI DESA NGLAWIYAN WILAYAH KERJA PUSKESMAS KOTA BLORA

Latar Belakang: Dikutip dari data hasil Riskesdas Kementerian Kesehatan Republik Indonesia tahun 2018, jumlah penderita Arthritis gout di Indonesia sebanyak 7,3% dari jumlah penduduk dengan prevalensi Arthritis gout di Jawa Tengah pada kelompok lansia 75 tahun ke atas sebesar 16,03%, kelompok lansia 65-74 tahun sebesar 13,90%, dan kelompok lansia 55-64 tahun sebesar 13,69%. Arthritis gout menyebabkan lansia mengalami nyeri yang hebat pada persendian dan organ tubuh lainnya. Tujuan: Menggambarkan asuhan keperawatan Arthritis gout pada lansia dengan fokus studi pengelolaan nyeri akut di Desa Nglawiyan, wilayah kerja Puskesmas Kota Blora. Metoda: Rancangan penelitian ini menggunakan pendekatan penelitian deskriptif, melalui studi kasus dan menggunakan pendekatan proses keperawatan. Pengumpulan data dilakukan dengan wawancara, observasi, pemeriksaan fisik, dan studi dokumentasi keperawatan. Hasil: Setelah dilakukan asuhan keperawatan lansia selama tiga hari, di dapatkan hasil klien mampu berpartisipasi dalam manajemen nyeri non-farmakologi  sehingga terdapat peningkatan dalam aktivitas. Saran yang diajukan, agar keluarga melakukan pendampingan manajemen nyeri non-farmakologi teknik relaksasi dan teknik distraksi pada klien lansia. Kata kunci: Arthritis gout, lansia, pengelolaan keperawatan nyeri, teknik relaksasi dan distraks

The Pathogenesis and Treatment of Gout

In the past, the etiology of gout was simplistically believed to be based in the generous indulgence of rich foods and alcohol. However, research has revealed that gout has complex environmental and genetic origins. Specifically, researchers have begun to focus attention on the molecular basis of gout and its related features. These features include hyperuricemia, the stages of gout, and the decreased solubility of uric acid. Furthermore, with epidemiologic evidence indicating that the prevalence of gout is consistently rising, it is imperative that medical providers understand the research-based guidelines for treatment. This includes what medications to administer, monitoring for drug-induced adverse effects, and modifying the treatment plan in elderly or unresponsive patients. Medical providers must also be aware of the importance of diet as a contributing factor to gout and which foods increase or decrease the risk of gout. This review will, therefore, attempt to present the current understanding of the pathophysiology of gout and guidelines for treatment and dietary modifications. Because gout is a disease related to metabolic dysfunction and produces arthritic symptoms, the information presented in this review was extracted from textbooks and journals chiefly relating to biochemistry, rheumatology, and pharmacology. The results of the research conducted revealed that there are three features that are genetically induced that independently contribute to the onset of gout: phosphoribosyl pyrophosphate (PRPP) synthetase hyperactivity, partial deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPT), and hyperactivity of the uric acid transporter in the renal tubule. In addition, diets rich in meat and seafood and devoid of dairy products substantially increase the risk of developing gout. Finally, research has indicated that the preferred treatment plan for gout includes using NSAIDs to alleviate the pain and inflammation of an acute gout attack, using colchicine for prophylactic therapy, and using either uricosurics or xanthine oxidase inhibitors for the long-term management of uric acid levels. Based on the results presented, medical providers will be better informed of methods to treat gout by knowing how to skillfully manage drug therapy, thereby reducing dangerous adverse effects and improving patient adherence to the drug regimen. In addition, by understanding the role of diet in the onset of gout, providers will better be able to advise patients on what foods to include or limit in their diet. From a research perspective, the elucidation of the pathophysiology of gout can lead to the development of even more effective therapeutic options

Gout

Gout is a syndrome caused by an inflammatory response creating an over production of uric acid increasing uric acid levels in the blood and body fluids. Gout is defined as a disorder resulting from tissue deposition of MSU crystals (in joints, bursae, bone, and certain other soft tissues, such as ligaments, tendons and occasionally, skin) and/or crystallization of uric acid within the renal collecting system (tubules and renal pelvis) that typically occurs in acid urine” (Terkeltaub & Edwards, 2013, p. 20). Gout is among the oldest diseases affecting approximately 3.9% of adults in America (Terkeltaub & Edwards, 2013, p. xv). Historically, Gout was the “disease of kings.” An early century caricature depicts gout in affluent middle-aged men that over indulge in alcohol and food. Today, the population stereotypes the average patient with impressions of self-limiting behavior such as drinking and diet (Terkeltaub & Edwards, 2013, p. xv). Gout prevalence and incidence are on the rise. Gout pathophysiology is complex and not easily understood affecting the patients’ quality of life. Gout treatment is associated with treatment failure and noncompliance. Consequently, “Most patients with gout are treated in general practice and never enter the domain of the rheumatologist, and general practitioners (GPs) are unlikely to read guidelines that are published in rheumatology journals or present on rheumatology websites” (Perry & Madhok, 2010, p. 2233). Increasing knowledge and understanding of gout, clinicians can significantly influence the quality of life through treatment options for patients and practitioners

Association between gout and atrial fibrillation: A meta-analysis of observational studies

Background: Gout is a systemic inflammatory arthritis characterized by the deposition of monosodium urate crystals due to hyperuricemia. Previous studies have explored the link between gout and atrial fibrillation (AF). Given the increasing prevalence and incidence of gout, there is a need to quantify the relationship between gout and the risk of AF. Therefore, we conducted a systematic review and meta-analysis on this topic. Methods: PubMed and Embase were searched for studies that reported the association between gout and AF using the following search term: (‘Gout’ and ‘Arrhythmia’). The search period was from the start of the database to 3rd August 2018 with no language restrictions. Results: A total of 75 and 22 articles were retrieved from PubMed and Embase, respectively. Of these, four observational studies (three cohort studies, one case-control study) including 659,094 patients were included. Our meta-analysis demonstrated that gout was significantly associated with increased risk of AF (adjusted hazard ratio: 1.31; 95% confidence interval: 1.00-1.70; P = 0.05; I2 = 99%) after adjusting for significant comorbidities and confounders. Conclusions: Our meta-analysis confirms the significant relationship between gout and AF. More data are needed to determine whether this risk can be adequately reduced by urate-lowering therapy