目的:探讨不同治疗方法对急性痛风性膝关节炎的治疗效果。方法:自2006年9月～2008年3月共收治42例急性痛风性膝关节炎患者。对21例急性痛风性膝关节炎患者采取药物保守治疗,21例行关节镜手术配合药物治疗。两组治疗前后采用WOMAC评分对膝关节功能进行评定,用student-t检验进行统计学分析。结果:保守组:随访发现关节症状好转不明显,复发率19.05％;WOMAC评分治疗前49～72分,治疗后69～85分。关节镜手术配合药物组:随访发现关节症状均明显缓解,关节功能恢复良好,伤口甲级愈合,无术后并发症,6个月无复发病例;WOMAC评分治疗前49～71分,治疗后75～96分。两组治疗前后及之间有显著性差异,保守组(t=-9.864,Plt;0.001);关节镜手术配合药物组(t=-11.267,Plt;0.001);两组之间(t=-2.366,Plt;0.023)。结论:比较以上2种治疗方法,关节镜手术治疗急性痛风性膝关节炎具有创伤小、起效快、效果明显、关节功能恢复满意等特有优势,结合药物治疗,能取得良好的治疗效果。
ObjectiveTo analyze the diagnostic value of gemstone spectral CT-imaging for urate crystal in joints and circum-tissues in patients with gout. MethodsBetween June 2013 and March 2014, 28 patients with gout confirmed by clinical and laboratory examination were reviewed retrospectively. The patients with peripheral joints suspected urate crystal due to gout underwent gemstone spectral CT scan on spectrum scanning gemstone spectral imaging (GSI) mode. Images were processed with GSI Viewer software. The visualization and distribution of urate crystal were noted. ResultsUrate crystal deposition in peripheral joints, tendon and ligaments of 28 patients were clearly displayed in uric acid (calcium) base images with gemstone spectral CT. The density of urate crystal in uric acid (calcium) base image was higher than that in calcium (uric acid) base image. The position of urate crystal deposition included metatarsophalangeal joint in 23 cases (82%), ankle joint in 4 cases (14%), and knee joint in 2 cases (8%), respectively, in which multi-locum suffered in 1 case. ConclusionUrate crystal deposition can be well depicted by gemstone spectral CT-imaging, which provides a new diagnosing method for gout without trauma. Gemstone spectral CT-imaging was greatly helpful for differential diagnosis of single joint sore pain.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on the treatment for acute gout.MethodsPubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating drug interventions therapy in acute gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs by the AMSTAR tool, and assessed the quality of the body of evidence for each outcome by the GRADE approach.ResultsA total of seven relevant SRs were included, which contains three main outcome measures. Four SRs contained non-steroidal anti-inflammatory drugs (NSAIDS), three SRs contained colchicine and two SRs contained glucocorticoids. All SRs assessed risk of bias of included original studies. Two used the Jadad scale or modified Jadad scale in this assessment while others used the " assessing risk of bias” tool recommended by Cochrane Collaboration. The assessment results of AMSTAR tool suggested that: three SRs were considered high quality (scores≥9), and the other four were considered moderate quality. GRADE results showed: the quality of the evidence of 11 outcomes was low or very low, and five outcomes was moderate.ConclusionsThe current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute gout, however, the priority of these drugs is still unclear. We suggest conducting new SRs and updating relevant SRs, to systematically compare different drug interventions therapy in acute gout with the latest evidence. In addition, we still expect to put more efforts in conducting high-quality original studies, in order to fill the gap of relevant fields and improve the level of evidence quality.
ObjectiveTo discuss the changes of joint fluid and blood-related indexes in patients with gouty arthritis and rheumatoid arthritis, and to analyze the clinical significance of these changes. MethodsSeventy-five patients with gouty arthritis and 68 with rheumatoid arthritis treated between January and December 2014 were included in our study. Their joint fluid-related indicators including white blood cell count (WBC), total protein (TP), albumin (ALB), glucose (GLU), and uric acid (UA), and their blood indicators including immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), C3 and C4, rheumatoid factor (RF), anti-streptolysin O (ASO), and c-reactive protein (CRP) were detected. ResultsFor joint fluid-related indicators, TP and ALB levels were not significantly different between the two groups (P > 0.05), while WBC, GLU, UA, RF and ASO between the two groups were significantly different (P < 0.05); For blood indexes, C4 was not significantly different between the two groups (P > 0.05), but IgG, IgM, IgA, CRP, C3, UA, RF and ASO were significantly different between the two groups (P < 0.05). The detection rate of ASO from the joint fluid was significantly higher than that detected from the blood in both the two groups (P < 0.05), while UA level was not significantly different between the joint fluid and the blood (P > 0.05). In patients with rheumatoid arthritis, RF detection rate was not significantly different between the joint fluid and the blood (P > 0.05), but it was significantly different for patients with gouty arthritis (P < 0.05). The positive rate of ASO in the blood and joint fluid of patients with gouty arthritis was respectively 38.7% and 44.0%, and it was 75.0% and 73.5% for patients with rheumatoid arthritis. UA positive rate in the blood and joint fluid of patients with gouty arthritis was 92.0% and 80.0% respectively, while it was 38.2% and 32.4% for patients with rheumatoid arthritis. RF positive rate was 33.3% and 40.0% in the blood and joint fluid of patients with gouty arthritis, while the rate was 86.8% and 91.2% for patients with rheumatoid arthritis. ConclusionThe joint fluid and blood indicators are in change in patients with gouty arthritis and rheumatoid arthritis, which has a certain clinical value in disease diagnosis and curative effect observation.
Objective To investigate the effectiveness of free palmaris longus tendon graft reconstruction in the treatment of gouty tophus erosion lesions in flexor tendon of wrist and hand. MethodsA retrospective analysis was conducted on 8 patients with gouty tophus erosion lesions in flexor tendon of wrist and hand who underwent free palmaris longus tendon graft reconstruction between June 2017 and December 2023. All patients were male, aged 22-65 years, with an average of 45.9 years. The duration of gout history ranged from 2 to 18 years, with an average of 8.8 years. The duration from the discovery of gouty tophus to operation ranged from 12 to 26 months, with an average of 17.6 months. The gouty tophus eroded the flexor pollicis longus tendon in 4 cases, with Verdan flexor tendon zones being Ⅰ-Ⅱ in 1 case and Ⅳ-Ⅴ in 3 cases. The flexor digitorum profundus tendons were affected in 2 cases for the index finger, 1 for the middle finger, and 1 for the ring finger, all located in zone Ⅳ-Ⅴ. The long axis of the gouty tophus ranged from 2.3 to 4.5 cm, with an average of 3.4 cm. All 8 patients presented with limited finger flexion and extension. Among them, 4 cases were accompanied by median nerve compression symptoms, and 1 case had associated bone and joint destruction in the hand. The total active motion (TAM) of the affected finger was (81.3±30.2)° before operation according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, and the functional evaluation was poor. The harvested palmaris longus tendon intraoperatively was 7-9 cm in length. Results Surgical incisions in all 8 patients healed by first intention, with no infections, graft non-union, or significant adhesion complications. All patients were followed up 8-25 months, with an average of 14.8 months. Numbness symptoms resolved in all 4 patients who presented with median nerve compression symptoms. Patients did not experience wrist pain or other discomfort, and function was not compromised. At last follow-up, according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, the TAM of 8 patients was (197.5±55.8)°, which significantly improved when compared with that before operation (t=11.638, P<0.001); the hand function of 1 patient with gouty tophus in zone Ⅰ-Ⅱ flexor pollicis longus tendon was good, and the other 7 patients were excellent. ConclusionFree palmaris longus tendon graft reconstruction demonstrates good effectiveness in treating gouty tophus erosion lesions in flexor tendon of wrist and hand.
ObjectiveTo optimize the extracting process of Zipu gouty mixture by orthogonal experiment, and to provide theoretical basis for its preparation procedure and quality control. MethodsThe water drawn extract yield and the total content of the chlorogenic acid were considered as research indexes. The orthogonal test was conducted to evaluate the effects of three factors including the amount of material/solvent ratio, extraction times, and duration of sample extraction of Zipu gouty mixture extracting process. ResultsThe extracting process was optimized with the material/solvent ratio of 1:8, extract time of 30 minutes for 3 cycles. ConclusionThe Zipu gouty mixture extracting process optimized by orthogonal test is simple, reliable and easy to repeat, which provides a theoretical basis for large-scale production.
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on urate-lowering therapy (ULT) for chronic gout. Methods PubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating urate-lowering drugs in chronic gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs using the AMSTAR tool, and assessed the quality of the body of evidence for each outcome using the GRADE approach. Results A total of 11 relevant SRs/Mets were included, containing 3 main outcome measures. All these SRs contained allopurinol. Ten SRs contained febuxostat, 3 SRs contained benzbromarone and 1 SR contained probenecid. Ten SRs assessed the risk of bias of included original studies. Eight SRs used the" assessing risk of bias”tool recommended by Cochrane Collaboration for this assessment while 2 used other tools. The assessment results of AMSTAR tool showed: the scores of 4 SRs were ≥9, and the others were ≤8. GRADE results showed: the quality of the evidence of 20 outcomes was low or very low, 10 outcomes was moderate and two outcomes was high. Conclusions Moderate quality evidence shows that febuxostat is beneficial in achieving target serum uric acid levels when comparing to allopurinol, and high quality evidence shows the incidence of gout flares is not significantly different between the two groups. High quality evidence also shows that the safety of febuxostat is better than allopurinol. Evidence of SRs is still insufficient to support the effectiveness and safety of other urate-lowering drugs. It is expected that more scientific and rigorous researches will be performed in the future, for which more high quality evidence will be produced to fill relevant gaps.
ObjectiveTo explore the clinical effects of wet dressing in treating non-healing wound caused by gout stone curettage. MethodsFifteen patients with non-healing wound after hand and foot gout curettage between April 2010 and January 2014 were included in our study. Medication, diet management, lifestyle changes, and health guidance were carried out before and after surgery to control patients' uric acid concentration. Through evidence-based method and considering the characteristics of gout stone curettage wound, we selectively used wet dressing to deal with the wound during the three processes of wound healing:debridement, hyperplasia, and maturing. The curative effect and patients' recovery were observed. ResultsAll the 15 cases of wound were cured, and the average treatment time was (40±5) days No recurrence occurred. ConclusionWet dressing can promote healing of gout stone curettage wound. With comprehensive treatment method, it can restore patients' health as soon as possible.
ObjectiveTo evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect.MethodsBetween July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7.ResultsThe incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences (t=22.532, P=0.000; t=22.702, P=0.000; t=6.124, P=0.000).ConclusionLesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.