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Does renal impairment protect from gout?
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Youssef P, Brama T, York H, Pickard P, Stewart P, McGill N: Does renal impairment protect from gout? J Rheumatol 1995, 22:494-496. In a study of 40 hyperuricemic patients with normal serum creatinine and 40 with elevated creatinine, the prevalence of gout was similar in the two groups. Only about half of the patients with renal insufficiency were on dialysis, and the 53% prevalence of gout in the control group in this study appears exceedingly high.
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Specificity in the recognition of crystals by antibodies
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Rigby AS, Wood PHN: Serum uric acid levels and gout: what does this herald for the population? Clin Exp Rheumatol 1994, 12:395-400. A history of podagra or abrupt attack in another joint proved to be the most useful criterion for diagnosing gout, whereas elevated serum uric acid and presence of tophi were poor discriminators. Serum urate levels were elevated in only 55% of patients with gout. The use of fasting urate levels and the apparent collection of data many years prior to the study, before diagnostic criteria were published, raises questions about the completeness of the data used in this study.
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Semin Arthritis Rheum
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Comparison of adrenocorticotropic hormone and triamcinolone acetonide in the treatment of acute gouty arthritis
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Siegel LB, Alloway JA, Nashel DJ: Comparison of adrenocorticotropic hormone and triamcinolone acetonide in the treatment of acute gouty arthritis. J Rheumatol 1994, 21:1325-1327. A single dose of intramuscular corticotropin (40 units) was compared with triamcinolone acetonide (60 mg) in acute gout. Repeat injection was required in nine of 15 patients receiving corticotropin but only in five of 16 receiving triamcinolone, and many patients receiving corticotropin required a third injection to treat rebound attacks, suggesting greater efficacy for triamcinolone.
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Baud FJ, Sabouraud A, Vicaut E, Taboulet P, Lang J, Bismuth C, Rouzioux JM, Scherrmann J-M: Brief report: treatment of severe colchicine overdose with colchicine-specific Fab fragments. N Engl J Med 1995, 332:642-645. A case of apparent life-saving treatment of a colchicine overdose with colchicine-specific Fab fragments was reported. The infusion of Fab fragments resulted in a dramatic reversal of hypotension and improvement in cardiac output. A transient rise in total plasma colchicine was probably explained by the mobilization of colchicine from peripheral sites.
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Ben-Chetrit E, Scherrmann J-M, Zylber-Katz E, Levy M: Colchicine disposition in patients with familial Mediterranean fever with renal impairment. J Rheumatol 1994, 21:710-713. The potential risks of colchicine in patients with renal and liver disease were emphasized in an analysis of colchicine disposition in patients with familial Mediterranean fever. The plasma half-life of colchicine was found to increase from 4.4 hours in patients with normal renal function to 18.8 hours in patients with renal failure. A patient with end-stage renal disease and hepatic cirrhosis had a colchicine plasma half-life of 50 hours. Colchicine should be given with extreme caution in patients with renal disease, especially in those with concomitant liver disease.
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