Gout
Gill Wakley, Ruth Chambers, Paul Dieppe in Musculoskeletal Matters in Primary Care, 2018
Gout is an inflammatory joint disease caused by the deposition of crystals of the sodium salt of uric acid in the joints. The joints most commonly affected are the first metatarso-phalangeal joint, the mid-tarsal joints and the knee. It has a prevalence of about 1% of the population, and is most common in men aged 40-50 years. If uric acid levels remain very high for a long period, deposits can form elsewhere, forming characteristic 'tophi' that can lead to the destruction of the adjacent tissues, including the joints. The typical acute attack is very characteristic. It usually starts at night, and may be precipitated by trauma or another illness. Gout with tophi is uncommon, and rarely occurs in the absence of a history of preceding acute attacks. The acute attack should be managed with anti-inflammatory medication, typically a 'decrescendo' regime of an NSAID. If NSAIDs are contra-indicated, a single high dose of steroid administered orally or intramuscularly is usually effective.
Mummy Medicine
Michael J. O’Dowd in The History of Medications for Women, 2020
Mummy produce could be ordered as balsams, extracts, ointments, powder or tinctures and these therapies formed part of the normal materia medica of apothecaries shops three to four centuries ago. One such therapy was Aqua Divina which derived from pulped mummy product. Despite the assertions of Pare and other illustrious medical men the use of mummy medicine continued right up to the eighteenth century. Indeed Bechers Parnassus Medicalis Illustratus of 1663 advocated mummy medicine for ‘delayed women’s time’ — similar to James Wolveridge’s indication — and also gave a recipe for artificial mummy. Mummy medicine was prescribed for various conditions, including epilepsy and gout; to inhibit or enhance blood clotting or as a panacea. The rationale for its use was based on a magical effect; mummies were ‘tangible symbols of longevity’. Palm wine used as an antiseptic, palm extract is now known to contain the female hormone estrogen (as do apple seeds, pomegranate seeds, Scots pine, and willow flowers).
The Afterlife in Ancient Egyptian Beliefs
Ibrahim M. Eltorai in A Spotlight on the History of Ancient Egyptian Medicine, 2019
The beliefs of the ancient Egyptians about the afterlife were richly developed with the inception of the concept of the soul in the religion of the Old Kingdom. The cult of Osiris envisaged a posthumous existence, which could be enjoyed not only by the royals, but also by all people of different ranks. The preservation of the body was important for the resurrection of the dead in the afterlife. In the 17th century A.D., an unthinkable practice developed, namely, the use of the mummy tissues as medicine. Pieces of the mummies were bought at high prices and recommended by physicians of that time to treat epilepsy, gout, and other ailments. There was a special place for mummification to which dead bodies were taken to perform the embalming in the most costly manner. The body cavity having been opened, the intestines, liver, spleen, kidneys, stomach, and pelvic viscera and most of the vessels were completely removed.
Spinal gout causing reversible quadriparesis: a case report and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Jaspreet Kaler, Osama Mukhtar, Mazin Khalid, Shivani Thapa, Ravinder Kaler, Brandon Ting, Vijay Gayam
Gout commonly affects peripheral joints and is rarely found in axial joints, such as the spine and sacroiliac joints. We report a case of a patient that presented with quadriparesis who was empirically treated for spinal gout and a review of relevant literature. A 77-year-old male presented with new-onset quadriparesis that developed over 3 days. MRI imaging was suggestive of tophaceous gout of the cervical spine, but our patient refused a spinal biopsy. He was empirically treated with high-dose steroids and his upper and lower extremities weakness started improving within 3 days and resolved completely. Although spinal gout is uncommon, this case indirectly suggests that gout should be kept as a differential diagnosis when faced with back pain or quadriparesis. This case implies that empiric treatment should be considered when radiographic evidence is suggestive of tophaceous gout of the spine.
Calcium pyrophosphate deposition disease: a frequent finding in patients with long-standing erosive gout
Published in Scandinavian Journal of Rheumatology, 2018
B Ankli, D Kyburz, A Hirschmann, T Hügle, T Manigold, CT Berger, T Daikeler
Objective: To characterize patients with both monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals in their synovial fluid (SF). Method: Forty-nine gout patients with acute arthritis were included. Those patients with MSU crystals only in their SF were compared to those patients with both MSU and CPP crystals in their SF. Results: A total of 36 out of 49 patients (73.5%) had only MSU crystals, whereas 13 out of 49 (26.5%) had both MSU and CPP crystals in their SF. Co-deposition of CPP crystals was associated with long-standing gout disease (p = 0.022), kidney dysfunction (p = 0.024), and erosive arthritis (p = 0.049), but not with age. Conclusion: Long-standing gout may be a risk factor for CPP deposition disease, and the frequency of CPP co-deposition may be higher than expected.
Case with long-standing gout showing various ultrasonographic features caused by monosodium urate monohydrate crystal deposition
Published in Modern Rheumatology Case Reports, 2020
Michito Murayama, Mutsumi Nishida, Yusuke Kudo, Takahiro Deguchi, Katsuji Marukawa, Yuichiro Fujieda, Nobuya Abe, Masaru Kato, Hitoshi Shibuya, Yoshihiro Matsuno, Tatsuya Atsumi
Gout, which is characterized by the deposition of monosodium urate monohydrate (MSU) in the synovial fluid and other tissues, is the most common form of inflammatory arthritis. Unlike the easily recognized acute and monoarticular gouty arthritis, advanced gout induces multiple finger joint disorders and may sometimes mimic rheumatoid arthritis (RA) or vice versa. The gold standard for gout diagnosis is the identification of MSU crystals via aspiration in the symptomatic joints or nodules; however, its feasibility and specificity may be inadequate. Recently, there have been important advances in imaging techniques, assisting in the non-invasive diagnosis of gout. Ultrasonography (US) has been known to have the ability to detect deposition of MSU crystals in patients with gout. Herein, we report an evocative case of long-standing gout with precisely detected specific US features indicating MSU crystal deposition and inflammation in multiple joints. Comprehensive US assessment included the bone, hyaline cartilage, soft tissue, subcutaneous nodules and tendon; we also discriminated gouty arthritis from RA.
Related Knowledge Centers
- Calcium Pyrophosphate
- Arthritis
- Purines
- Pyrimidines
- Monosodium Urate
- Crystal Arthropathies
- Calcium Phosphates