1
|
Mikuls TR, Soto Q, Petro A, Helget L, Roul P, Sayles H, Cope B, Neogi T, LaMoreaux B, O’Dell JR, England BR. Comparison of Rates of Lower Extremity Amputation in Patients With and Without Gout in the US Department of Veterans Affairs Health System. JAMA Netw Open 2022; 5:e2142347. [PMID: 34989795 PMCID: PMC8739736 DOI: 10.1001/jamanetworkopen.2021.42347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
Importance Cardiometabolic and other risk factors could render patients with gout more likely to undergo lower extremity amputation (LEA). Objective To examine the rate of and factors associated with LEA in patients with gout. Design, Setting, and Participants In this matched cohort study using national administrative data, multivariable Cox proportional hazards regression models were used to examine the associations of gout with LEA. In analyses limited to patients with gout, attributes of serum urate control and treatment with urate-lowering therapy were examined as factors associated with LEA. This study included patients who used US Department of Veterans Affairs services from January 1, 2000, to July 31, 2015. Patients with gout were identified using diagnostic codes and matched with up to 10 controls by age, sex, and year of benefit enrollment. Data analysis was performed from January 26, 2021, to September 3, 2021. Exposures Gout classification served as the primary independent variable of interest. In analyses limited to patients with gout, factors associated with serum urate control and urate-lowering therapy were examined. Main Outcomes and Measures Overall LEA, as well as toe, transmetatarsal, below-the-knee, and above-the-knee amputation. Results This cohort study included 5 924 918 patients, 556 521 with gout (mean [SD] age, 67 [12] years; 550 963 (99.0%) male; 88 853 [16.0%] Black non-Hispanic; 16 981 [4.3%] Hispanic/Latinx; 345 818 [62.1%] White non-Hispanic; 80 929 [14.5%] with race and ethnicity data missing; and 23 940 [4.3%] classified as other) and 5 368 397 without gout (mean [SD] age, 67 [12] years; 5 314 344 [99.0%] male; 558 464 [10.4%] Black non-Hispanic; 204 291 [3.0%] Hispanic/Latinx; 3 188 504 [59.4%] White non-Hispanic; 1 257 739 [23.4%)] with race and ethnicity data missing; and 159 399 [3.0%] classified as other). Compared with patients without gout, patients with gout were more likely to undergo amputation, an increased rate that remained after adjustment (adjusted hazard ratio, 1.20; 95% CI, 1.16-1.24) and was highest for below-the-knee amputation (adjusted hazard ratio, 1.59; 95% CI, 1.39-1.81). In those with gout, poor serum urate control (mean >7 mg/dL during the preceding year) was associated with a 25% to 37% increase in the rate of amputation. In contrast, treatment with urate-lowering therapy was not associated with the LEA rate. Conclusions and Relevance In this matched cohort study, patients with gout were more likely to undergo LEA. This increase was independent of other comorbidities that have been associated with amputation, including diabetes and peripheral vascular disease. Serum urate control was independently associated with the LEA rate, suggesting the possibility that lower extremity amputation may be preventable in some patients.
Collapse
Affiliation(s)
- Ted R. Mikuls
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Quint Soto
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Alison Petro
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Lindsay Helget
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Punyasha Roul
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Harlan Sayles
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Brendan Cope
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - James R. O’Dell
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Bryant R. England
- Veterans Affairs Nebraska–Western Iowa Health Care System, Omaha, Nebraska
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| |
Collapse
|
2
|
Septic Arthritis: An Evidence-Based Review of Diagnosis and Image-Guided Aspiration. AJR Am J Roentgenol 2020; 215:568-581. [PMID: 32783556 DOI: 10.2214/ajr.20.22773] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this evidence-based review is to equip radiologists to discuss and interpret findings obtained with various imaging modalities, guide patient selection for percutaneous aspiration, and safely perform arthrocentesis to assess for infection in both native and prosthetic joints. CONCLUSION. Septic arthritis is an emergency that can lead to rapidly progressive, irreversible joint damage. Despite the urgency associated with this diagnosis, there remains a lack of consensus regarding many aspects of the management of native and periprosthetic joint infections.
Collapse
|
3
|
Lee YWM, Kok SXS, Wong LW, Wong BSS. Clinics in diagnostic imaging (200). Intra-articular chronic tophaceous gout of the knee. Singapore Med J 2019; 60:502-507. [PMID: 31663097 DOI: 10.11622/smedj.2019129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 39-year-old man presented with acute left knee pain and swelling. There was limitation of movement of the knee joint. His past medical history was significant for gout. Computed radiography showed bony erosions that were not typical of chronic tophaceous gout. Magnetic resonance (MR) imaging showed focal deposits within the knee joint, which demonstrated isointense signal to muscle on T1-weighted sequence and intermediate signal on proton density (PD) and PD fat-saturated sequences. There was extensive, similar signal abnormality in the cruciate ligaments, popliteus tendon and lateral meniscus. These findings were in keeping with an intra-articular manifestation of chronic tophaceous gout. The clinical presentation and imaging features are herein discussed, with an emphasis on MR imaging.
Collapse
Affiliation(s)
| | | | - Li Weng Wong
- Department of Radiology, Sengkang General Hospital, Singapore
| | | |
Collapse
|
4
|
Tinevez D, Knezevic NN. Citrobacter koseri causing osteomyelitis in a diabetic foot with concomitant acute gouty arthritis successfully treated with ertapenem. BMJ Case Rep 2019; 12:12/7/e230432. [PMID: 31352398 DOI: 10.1136/bcr-2019-230432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present an elderly diabetic man with left hallux pain and drainage who was initially diagnosed with acute gouty arthritis using the diagnostic rule for acute gout and monosodium urate crystals presented on synovial fluid analysis. Further investigation with surgical debridement, plain X-ray, MRI and wound culture revealed concomitant Citrobacter koseri septic arthritis with osteomyelitis. C. koseri is considered an opportunistic infection that rarely causes musculoskeletal infections. Acute gouty arthritis and septic arthritis are rarely seen occurring concomitantly in the same joint and are often difficult to differentiate due to similar findings on exam and imaging. The present case illustrates that osteomyelitis with an opportunistic organism can present concomitantly with acute gouty arthritis, and the diagnosis of one should not exclude the other.
Collapse
Affiliation(s)
- Dillon Tinevez
- Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Nebojsa Nick Knezevic
- Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Anesthesiology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| |
Collapse
|
5
|
Jacques T, Michelin P, Badr S, Nasuto M, Lefebvre G, Larkman N, Cotten A. Conventional Radiology in Crystal Arthritis: Gout, Calcium Pyrophosphate Deposition, and Basic Calcium Phosphate Crystals. Radiol Clin North Am 2017; 55:967-984. [PMID: 28774457 DOI: 10.1016/j.rcl.2017.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews the main radiographic features of crystal deposition diseases. Gout is linked to monosodium urate crystals. Classic radiographic features include subcutaneous tophi, large and well-circumscribed paraarticular bone erosions, and exuberant bone hyperostosis. Calcium pyrophosphate deposition (CPPD) can involve numerous structures, such as hyaline cartilages, fibrocartilages, or tendons. CPPD arthropathy involves joints usually spared by osteoarthritis. Basic calcium phosphate deposits are periarticular or intraarticular. Periarticular calcifications are amorphous, dense, and round or oval with well-limited borders, and most are asymptomatic. When resorbing, they become cloudy and less dense with an ill-defined shape and can migrate into adjacent structures.
Collapse
Affiliation(s)
- Thibaut Jacques
- Division of Radiology and Musculoskeletal Imaging, University Hospital of Lille, Rue du Professeur Emile Laine, Lille Cedex 59037, France; University of Lille, 42, rue Paul Duez, Lille 59000, France.
| | - Paul Michelin
- Department of Radiology, CHRU de Rouen, 1 rue de Germont, Rouen Cedex 76031, France
| | - Sammy Badr
- Division of Radiology and Musculoskeletal Imaging, University Hospital of Lille, Rue du Professeur Emile Laine, Lille Cedex 59037, France; University of Lille, 42, rue Paul Duez, Lille 59000, France
| | - Michelangelo Nasuto
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Guillaume Lefebvre
- Division of Radiology and Musculoskeletal Imaging, University Hospital of Lille, Rue du Professeur Emile Laine, Lille Cedex 59037, France; University of Lille, 42, rue Paul Duez, Lille 59000, France
| | - Neal Larkman
- Department of Radiology, Leeds Teaching Hospital Trust, Chapeltown Road, Leeds, West Yorkshire LS7 4SA, UK
| | - Anne Cotten
- Division of Radiology and Musculoskeletal Imaging, University Hospital of Lille, Rue du Professeur Emile Laine, Lille Cedex 59037, France; University of Lille, 42, rue Paul Duez, Lille 59000, France
| |
Collapse
|
6
|
Shah D, Mohan G, Flueckiger P, Corrigan F, Conn D. Polyarticular Gout Flare Masquerading as Sepsis. Am J Med 2015; 128:e11-2. [PMID: 25614957 DOI: 10.1016/j.amjmed.2014.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Deep Shah
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
| | - Gopi Mohan
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Peter Flueckiger
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Frank Corrigan
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Department of Cardiology, Emory University School of Medicine, Atlanta, Ga
| | - Doyt Conn
- Department of Rheumatology, Emory University School of Medicine, Atlanta, Ga
| |
Collapse
|
7
|
Tophaceous gout mimicking osteomyelitis: the value of musculoskeletal ultrasound in establishing the diagnosis. J Clin Rheumatol 2010; 16:295-7. [PMID: 20808172 DOI: 10.1097/rhu.0b013e3181eeecbe] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
8
|
Abstract
Gout is a common arthritis caused by deposition of monosodium urate crystals within joints after chronic hyperuricaemia. It affects 1-2% of adults in developed countries, where it is the most common inflammatory arthritis in men. Epidemiological data are consistent with a rise in prevalence of gout. Diet and genetic polymorphisms of renal transporters of urate seem to be the main causal factors of primary gout. Gout and hyperuricaemia are associated with hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular diseases. Non-steroidal anti-inflammatory drugs and colchicine remain the most widely recommended drugs to treat acute attacks. Oral corticosteroids could be an alternative to these drugs. Interleukin 1beta is a pivotal mediator of acute gout and could become a therapeutic target. When serum uric acid concentrations are lowered below monosodium urate saturation point, the crystals dissolve and gout can be cured. Patient education, appropriate lifestyle advice, and treatment of comorbidities are an important part of management of patients with gout.
Collapse
Affiliation(s)
- Pascal Richette
- Université Paris 7, UFR Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France. pascal.richette@lrb
| | | |
Collapse
|
9
|
Yehia B, Flynn J, Sisson S. Crystal clear. Am J Med 2008; 121:488-90. [PMID: 18501227 DOI: 10.1016/j.amjmed.2007.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/06/2007] [Accepted: 12/11/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Baligh Yehia
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
| | | | | |
Collapse
|
10
|
Gómez Rodríguez N, Ibáñez Ruán J, González Pérez M. [Not Available]. REUMATOLOGIA CLINICA 2008; 4:80-82. [PMID: 21794504 DOI: 10.1016/s1699-258x(08)71806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
11
|
Abstract
Gout is a disease of antiquity but is increasing once again in prevalence despite availability of reasonably effective treatments. This may be related to a combination of factors, including diet, obesity, and diuretic use. Allergic reactions, noncompliance, drug interactions, and sometimes inefficacy all limit the effective use of current hypouricemic agents. There are new treatments for gout on the horizon, including febuxostat, a nonpurine inhibitor of xanthine oxidase with a potentially better combination of efficacy and side effects than allopurinol. Diagnostic progress is being made in that ultrasound may offer a noninvasive means of diagnosing tophaceous deposits in and around joints. The increasing prevalence of gout means that dermatologists will see more cutaneous manifestations of gout, including tophi, draining sinus tracts, panniculitis, and dystrophic calcifications.
Collapse
Affiliation(s)
- Gerald F Falasca
- Division of Rheumatology, Cooper University Hospital, Robert Wood Johnson Medical School at Camden, University of Medicine and Dentistry of New Jersey, Camden, NJ 08103, USA.
| |
Collapse
|
12
|
Abstract
Subchondral cystic lesions are common features that are associated with many arthropathies and synovial-based processes. Although not comprehensive in scope, this article correlated the pathophysiology and imaging features of several of these disorders to better understand the associated subchondral lucencies. The imaging features of these subchondral cystic lesions were described in each process, and, in some cases, demonstrated overlapping features. By becoming familiar with the disease processes and recognizing the imaging appearances and associated clinical findings, the radiologist will be better able to differentiate these benign entities from more aggressive processes, such as tumor. Subchondral cystic lesions are common features that are associated with many arthropathies and synovial-based processes. Although not comprehensive in scope, this article correlated the pathophysiology and imaging features of several of these disorders to better understand the associated subchondral lucencies. The imaging features of these subchondral cystic lesions were described in each process, and, in some cases, demonstrated overlapping features. By becoming familiar with the disease processes and recognizing the imaging appearances and associated clinical findings, the radiologist will be better able to differentiate these benign entities from more aggressive processes, such as tumor.
Collapse
Affiliation(s)
- Laura W Bancroft
- Department of Radiology, Mayo Clinic College of Medicine, 4500 San Pablo Boulevard, Jacksonville, FL 32207, USA.
| | | | | |
Collapse
|
13
|
Affiliation(s)
- Aravind S Ravi Kumar
- Department of Nuclear Medicine and Ultrasound, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|