ObjectiveAicardi and Goutières syndrome was first reported as a rare hereditary encephalopathy with white matter involvement in 1984. Typical clinical manifestations include severe mental motor development retardation or regression, pyramidal and extrapyramidal symptoms and signs, epilepsy, microcephaly and frostbite.MethodsTo collect a case of patient who presented with convulsions 14 days after birth without obvious inducement. The child was diagnosed as epilepsy in the local hospital and the symptoms improved after treatment with antiepileptic drugs. At 4 months, the child presented nods and clenched fists, and was diagnosed as infantile spasm. After Adrenocorticotrophic hormone and drug treatment, the symptoms gradually improved. Due to upper respiratory track infection, the child was aggravated at the age of 1 year and 2 months, and then diagnosed as Aicardi-Goutières syndrome by video EEG, skull MRI, fundus and gene screening.ResultsSurgery and treatment with antiepileptic drugs significantly improved the symptoms of the child, and the pathological biopsy of the brain tissue supported the previous diagnosis.ConclusionsThe report of this case will help to improve the clinician's diagnosis and treatment of Aicardi-Goutières syndrome.
Objective To investigate the method and the effectiveness of a combination of the arthroscopic debridement and joint irrigation postoperatively for treating gouty arthritis of the knee. Methods Between August 2000 and November 2009, 41 patients with gouty arthritis of the knee were treated by arthroscopic debridement. All patients were males with an average age of 42 years (range, 21-71 years), including 8 incipient cases and 33 relapsed cases. The unilaterial knees wereinvolved in 36 cases, including 22 left knees and 14 right knees, and both in 5 cases. The disease duration ranged from 2 months to 20 years (median, 6 years and 2 months). The extention, flexion, and range of motion (ROM) of the knee joint were (4.88 ± 6.22), (93.95 ± 35.33), and (87.79 ± 35.19)°, respectively, and Lysholm score was 63.2 ± 11.7 preoperatively. The serum uric acid levels were higher than normal value in 32 cases. Twenty-seven cases were definitely diagnosed as gouty arthritis before operation. Arthroscopic debridement was performed in 11 cases, and the arthroscopic debridement with joint irrigation postoperatively in 30 cases. After operation, the anti-gout agents and diet control were given. Results Arthroscope and pathologic examinations confirmed diagnosis of gouty arthritis in 41 patients. Intra-articular hemorrhage occurred in 1 case and was cured after arthroscopic evacuation of hematoma. The other patients achieved heal ing of incision by first intention. All 41 patients were followed up 15-126 months (mean, 50 months) postoperatively. The Lysholm score was 96.8 ± 5.8 at 15 months after operation, showing significant difference when compared with the preoperative value (t= — 13.844, P=0.000). The postoperative extention (1.16 ± 3.91)°, flexion (125.93 ± 18.65)°, and ROM (126.86 ± 16.33)° of the knee joint were significantly improved when compared with the preoperative ones (P lt; 0.05). Thirteen cases (14 knees) recurred postoperatively; but occurrence frequency and the duration were decreased and the symptoms of joint swell ing and pain were improved. Conclusion The arthroscopicdebridement is effective in cleaning up uric acid crystals thoroughly, reducing wounds, and speeding up recovery. If antigout agents and diet control can be used postoperatively, the recurrence of gouty arthritis can be prevented effectively, and the progression can be delayed.
ObjectiveTo investigate the clinical nursing path of health education in patients with gout. MethodsA total of 220 patients with gout treated in People's Hospital of Jiangyou from September 2010 to November 2011 were randomly divided into observation group and control group with 110 patients in each.After routine health education for the control group and clinical nursing path health education for the observation group,we compared patients'compliance with doctors,gout-related indicators and health education satisfaction degree between the two groups of patients. ResultsThere was no statistically significant difference in compliance with doctors between the two groups before health education (P>0.05).After health education,the score of five single items on compliance with doctors and the total score for patients in the observation group were all significantly improved (P<0.05).For patients in the control group,the scores of each item and the total score were also significantly improved (P<0.05) except the item of regular drug-taking and regular health examination (P>0.05).After health education,all scores and the total score of the observation group were higher than those of the control group (P<0.05). ConclusionFor health education for gout patients,clinical nursing path is better than routine health education in scores of compliance with doctors,improvements of symptoms,and health education satisfaction degree of the patients.
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 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.
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.
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.
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.
Gout is the most common inflammatory arthritis, which is characterized by elevated urate and monosodium urate (MSU) crystal deposition in tissues, leading to arthritis, soft-tissue masses (tophi), nephrolithiasis, and urate nephropathy. It has a major impact on health-related quality of life. The American College of Rheumatology (ACR) published ACR guidelines for the management of gout in June 2020, in which 42 recommendations (including 16 strong recommendations) were generated. The guideline described indications for urate-lowering therapy (ULT), approaches to initiating, ongoing management, gout flares, and lifestyle and other medication strategies in patients with gout and in individuals with asymptomatic hyperuricemia. This paper interprets it to provide references for clinical practice.