A Patient with Complex Gout with an Autoinflammatory Syndrome and a Sternoclavicular Joint Arthritis as Presenting Symptoms

Fedeli, M. M.; Vecchi, Maurizio; Cassis, P. Rodoni

doi:10.1155/2020/5026490

Cited by 7 publications

(8 citation statements)

References 8 publications

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“…The symptoms of GA include swollen and painful joints, elevated local skin temperature, dysfunction of activity, and fever [ 2 , 3 ]. Low-grade fever is predominant [ 2 ], whereas high-grade fever is occasionally observed [ 4 ]. The clinical manifestations of acute gouty arthritis with fever (AGA–fever) are similar to those of infective fever; therefore, both conditions are indistinguishable.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Risk Factors of Fever in Acute Gouty Arthritis

Huang

Zhou

Yuan

2022

BioMed Research International

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Objectives. This study aimed to investigate the clinical characteristics and risk factors of fever in hospitalised patients with acute gouty arthritis (AGA). Methods. The clinical data of 167 hospitalised patients with AGA who met the inclusion criteria were retrospectively analysed. The demographic, clinical, and medication data of patients with and without fever were compared, and risk factors associated with fever were identified via logistic regression analysis. Results. The incidence of fever in hospitalised patients with AGA was 31.1%, with low-grade fever being predominant. Visual analogue scale (VAS) scores, white blood cell counts, neutrophil proportion, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were higher in the fever group than in the non-fever group ( P < 0.05 for all). In addition, the incidence rates of arthritis of single knee and polyarthritis were higher in patients in the fever group ( P < 0.05 ). The proportion of patients who received betamethasone injection and combination therapy were higher in the fever group ( P < 0.05 ). However, no significant differences were observed in age; sex; uric acid (UA) levels; and the incidence rate of hypertension, diabetes mellitus, cardiovascular disease, and renal function abnormalities between the two groups. Logistic regression analysis revealed that arthritis of single knee, polyarthritis, age of ≥65 years, CRP levels, and VAS scores were risk factors for concomitant AGA and fever. Among these factors, CRP levels and VAS scores were identified as independent risk factors (odds ratio [OR], 1.014 and 1.686, respectively; 95% confidence interval [CI], 1.004–1.025 and 1.115–2.549, respectively; P < 0.05 for both). Conclusion. The incidence of fever is high in hospitalised patients with AGA. Elderly patients, patients with arthritis affecting only one knee, and those with polyarthritis are predisposed to fever. In addition, the risk of developing fever increases with increasing VAS scores and CRP levels, and patients presenting with fever require enhanced anti-inflammatory and analgesic therapy.

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Section: Introductionmentioning

confidence: 99%

Clinical Features and Risk Factors of Fever in Acute Gouty Arthritis

Huang

Zhou

Yuan

2022

BioMed Research International

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“…Gout was polyarticular in 46.4% of the patients and tophaceous in 53.8%. Some of the patients presented atypical forms of the disease such as spinal gout ( 25 , 30 ), autoinflammatory syndromes ( 27 ), and sternoclavicular joint arthritis ( 34 ). Most of the patients had more than one associated comorbidity among the following: hypertension (70.7%), CKD ≥3 (52.85%), DM (35.4%; Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature

et al. 2023

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BackgroundGout is the most common type of inflammatory arthritis. Nonsteroidal anti-inflammatory drugs, corticosteroids, and colchicine are the first-line agents, although they are contraindicated in many patients. Blockade of IL-1 with anakinra can be an alternative.ObjectiveTo present a case series of 10 difficult-to-treat gout patients treated with anakinra and perform a scoping review of the effectiveness and safety of anakinra in gout patients.MethodsA total of 1,519 citations were screened. The reviewers ran a two-stage screening process by title/abstract and full-text reading. Thirty-eight articles finally met the selection criteria and were included for data extraction and synthesis. Experience in difficult-to treat and complex clinical scenarios, such as active infection, hemodialysis, and transplantation, were specifically described.ResultsThe study sample comprised 551 patients, from whom 648 flares were finally analyzed. The mean age was 57.9 years, and 82.9% were men. The clinical presentation was polyarticular in 47.5% and tophaceous in 66.9%. Sixty-five patients with an active infection, 41 transplanted patients and 14 in haemodyalisis treated with anakinra are described. More than half of the patients had >1 associated comorbidity. Anakinra was effective both for flares (94%) and for long-term treatment (91%) and well tolerated. In the case of flares, 34 (6.7%) adverse effects were registered. Adverse events were more prevalent in long-term treatment.ConclusionAnakinra was effective and safe for management of gout flares in difficult-to-treat patients. It has been used in multiple complex scenarios, such as active infections, dialysis, transplantation, chronic kidney disease, and polyarticular gout. Anakinra has also proven effective as long-term treatment, although there are more concerns about its safety.

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“…Tophaceous gout located in the SCJ is an extremely unusual condition. From our literature search, we have found evidence of only two cases of true gout affecting the SCJ prior to this case [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Fedeli et al . [ 4 ] describe the use of duel-energy CT (DECT) to help diagnose gout in cases of doubt or unusual locations. With this technique, it is possible to differentiate uric acid crystals within the bone from calcium-based dystrophic calcification.…”

Section: Discussionmentioning

confidence: 99%

Tophaceous gout in the sternoclavicular joint

Sahdev

Smelt

Ávila

et al. 2020

Journal of Surgical Case Reports

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Gouty arthritis commonly occurs in peripheral synovial joints and involvement in the thoracic cage is extremely rare. We report a case of a 52-year-old presenting with a painful bony mass in her sternal notch. Imaging demonstrated a lobulated calcified and necrotic lesion causing mass effect on adjacent structures. Excision biopsy confirmed a benign cystic lesion with amorphous material containing needle-shaped refractile crystals suggestive of uric acid. Tophaceous gout was diagnosed. Presence of a periarticular mass with characteristics of gout should warrant investigation with biopsy and imaging. This can prevent misdiagnosis of malignancy and avoid unnecessary surgery in asymptomatic lesions.

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A Patient with Complex Gout with an Autoinflammatory Syndrome and a Sternoclavicular Joint Arthritis as Presenting Symptoms

Cited by 7 publications

References 8 publications

Clinical Features and Risk Factors of Fever in Acute Gouty Arthritis

Clinical Features and Risk Factors of Fever in Acute Gouty Arthritis

Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature

Tophaceous gout in the sternoclavicular joint

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