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Acute gouty synovitis associated with "urate milk"
A G Fam1, M D Reis, J P Szalai
1Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
The Journal of Rheumatology
|February 7, 1998
Summary
This study describes rare cases of acute gouty synovitis with milky, urate-filled joint fluid. Ethanol abuse was a common risk factor for gout in these patients.
Area of Science:
- Rheumatology
- Crystal-induced arthritis
- Synovial fluid analysis
Background:
- Acute gouty synovitis typically presents with inflammatory joint effusions.
- Milky white, chalky synovial effusions are an unusual presentation of gout.
Purpose of the Study:
- To characterize the clinical features of acute gouty synovitis with milky, urate-laden synovial effusions.
- To investigate the impact of urate-rich synovial fluid on white blood cell (WBC) counts in vitro.
Main Methods:
- Case series of five male patients with acute gouty synovitis and "urate milk" between 1993 and 1996.
- Analysis of synovial fluid characteristics, including crystal content and WBC counts.
- In vitro incubation of leukocyte-rich rheumatoid effusions with urate-laden synovial fluid.
Main Results:
- Synovial effusions were thick, chalky, and milky white, packed with monosodium urate (MSU) crystals.
- Massive MSU crystals interfered with accurate WBC counts; one patient had 6750 WBC/mm³ with 91% neutrophils.
- Ethanol abuse was identified as a frequent risk factor in four or five patients.
- Incubation with urate-laden fluid reduced WBC counts in rheumatoid effusions compared to controls.
Conclusions:
- Milky white synovial effusions with massive urate crystals ("urate milk") are a rare manifestation of acute gouty arthritis or bursitis.
- Ethanol abuse is a significant risk factor for hyperuricemia and gout in affected individuals.