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A clinical study of crystal-proven gouty arthritis in a university hospital
Worawit Louthrenoo1, Nuntana Kasitanon, Waraporn Sukitawut
1Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Insights
This study reviews crystal-proven gout cases in Thailand, finding common joint involvement and associated conditions like hypertension and renal issues. Gout patients in northern Thailand showed higher rates of tophi, renal failure, and calculi compared to Bangkok. Keywords: gout, crystal-proven gout, renal insufficiency, tophi.
Area of Science:
- Rheumatology
- Nephrology
- Clinical Medicine
Background:
- Gout is a common inflammatory arthritis characterized by monosodium urate crystal deposition.
- Understanding the clinical spectrum of gout is crucial for effective patient management and public health strategies.
Purpose of the Study:
- To describe the clinical features of crystal-proven gout in a university hospital in northern Thailand.
- To compare these features with those previously reported in Bangkok.
Main Methods:
- Retrospective review of 567 patients with crystal-proven gout.
- Analysis of patient demographics, age at onset, disease duration, affected joints, presence of tophi, associated comorbidities, and renal status.
Main Results:
- The mean age at onset was 60.0 years, with a mean disease duration of 5.2 years. Recurrent attacks occurred in 94% of patients.
- The ankle and knee were most commonly affected in initial attacks, while ankle, knee, and first metatarsophalangeal joints were most affected during recurrent attacks.
- Associated conditions included hypertension (common), hyperlipidemia, diabetes mellitus, and ischemic heart disease. Tophaceous gout (36%), renal calculi (35%), and renal insufficiency (54%) were prevalent. Hyperexcretion was noted in 12% of patients with normal renal function.
Conclusions:
- Clinical features of gout in northern Thailand are similar to Bangkok but present with a higher incidence of tophaceous gout, renal failure, and renal calculi.
- The study highlights the significant burden of gout and its complications, emphasizing the need for comprehensive management strategies.
Abstract:
The clinical features of 567 patients with crystal proven gout (489 males, 78 females) seen in a University Hospital in northern Thailand was reviewed. The mean age at onset and mean duration of disease was 60.0 +/- 11.7 years and 5.2 + 4.8 years, respectively. Recurrent attacks accounted for 94 per cent. The knee and ankle were the 2 most common joints affected during the first attack and each one was seen in 55.6 per cent of cases. During a recurrent attack, the ankle, knee and first metatarsophalangeal joint were the 3 most common joints affected and were seen in 94.5 per cent, 81.2 per cent and 80.2 per cent of cases, respectively. Thirty-six per cent of the patients had tophi. Hypertension, hyperlipidemia, diabetes mellitus and ischemic heart disease were commonly associated diseases. Thirty-five per cent had renal calculi, and fifty-four per cent had renal insufficiency. Of 59 patients who tested with normal renal function, twelve per cent were hyperexcretor. The clinical features of gout seen in the university hospital in northern Thailand were similar to those reported in Bangkok, but with a higher incidence of tophaceous gout, renal failure and renal calculi.
