Goutte et arthrose : un lien pathogénique ?
Article: The pathogenesis of podagra.[Show abstract] [Hide abstract]
ABSTRACT: Precipitation of crystals from solution is a relatively simple phenomenon that should be explained by changes in concentration, temperature, pH, or other local factors. Which of these factors determines the preferential precipitation of urate crystals at the base of the big toe? Podagra correlates with degenerative joint disease of the toe, often follows abuse of the feet, and classically occurs in the middle of the night. These characteristics suggest that crystals may form in resolving synovial effusions. The urate concentration must transiently rise in such an effusion because water will leave the joint space twice as fast as urate. If the local concentration surpasses the solubility of urate, crystals will form that may than induce acute podagra.Annals of internal medicine 03/1977; 86(2):230-3. DOI:10.7326/0003-4819-86-2-230 · 16.10 Impact Factor
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ABSTRACT: To analyze the clinical features and identify factors associated with the development of gouty arthritis in nodal osteoarthritis (OA). Thirty-two consecutive patients (21 women and 11 men, mean age 75.8 years) with both nodal OA and crystal proven acute gout and/or tophi of distal/proximal interphalangeal (DIP/PIP) joints were studied between 1986 and 1994. Tophi of DIP and/or PIP joints were present in 29 (90%) patients; alone in 9 and together with acute DIP or PIP gouty arthritis in 20. Three patients had acute DIP or PIP gouty episodes but no digital tophi. Mean pretreatment serum urate was 614.9 +/- 163.2 (range 422-1088 mumol/l). Risk factors for gout included diuretic use (81%), renal failure (59%), hypertension (66%), alcoholism (22%), prophylactic low dose ASA (20%), and a positive family history (16%) of patients. The coexistence of gouty arthritis in nodal OA is important to recognize and treat, particularly in elderly women with renal failure, hypertension, or cardiac failure who are receiving longterm diuretic therapy.The Journal of Rheumatology 05/1996; 23(4):684-9. · 3.17 Impact Factor
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ABSTRACT: To determine whether joints affected by gout are also affected by osteoarthritis (OA). A postal questionnaire was sent to all adults aged over 30 years registered with two general practices. The questionnaire assessed a history of gout (doctor diagnosed, or episodes suggestive of acute crystal synovitis) and medication use. Patients who possibly had gout attended for clinical assessment to verify the diagnosis on clinical grounds and assess the distribution of joints affected by acute attacks of gout and OA. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated between the history of an acute attack of gout and the presence of OA at an individual joint adjusted for age, gender, body mass index and prior diuretic use in a binary logistic regression model. A total of 4249 completed questionnaires were returned (32%). From 359 attendees, 164 cases of gout were clinically confirmed. A highly significant association existed between the site of acute attacks of gout and the presence of OA (aOR 7.94; 95% CI 6.27, 10.05). Analysis at individual joint sites revealed a significant association at the first metatarsophalangeal joint (aOR 2.06; 95% CI 1.28, 3.30), mid-foot (aOR 2.85; 95% CI 1.34, 6.03), knee (aOR 3.07; 95% CI 1.05, 8.96) and distal interphalangeal joints (aOR 12.67; 95% CI 1.46, 109.91). Acute attacks of gout at individual joint sites are associated with the presence of clinically assessed OA at that joint suggesting that OA may predispose to the localised deposition of monosodium urate crystals.Annals of the Rheumatic Diseases 11/2007; 66(10):1374-7. DOI:10.1136/ard.2006.063768 · 9.27 Impact Factor