Medicine and Health Sciences Commons^™

Unveiling The Complexity Of Nocardia Septic Arthritis In An Immunocompromised Patient: A Case Report, Steven A. Kessler, Meghan R. Mansour, Ali Khreisat, Mamon Tahhan

HCA Healthcare Journal of Medicine

Background

Nocardiosis is the systemic manifestation of Nocardia infection, often found in immunocompromised individuals. Nocardia are transmitted via inhalation or skin wounds, disseminating hematogenously to organs and rarely, joints. We present a patient with immunosuppression who developed gout of the knee with superimposed Nocardial septic arthritis and a possible subsequent systemic infection.

Case Presentation

A 74-year-old man presented with left lower extremity swelling and pain. He was taking immunosuppressive medication for antineutrophilic cytoplasmic antibody-positive vasculitis. A week prior, an arthrocentesis test was positive for gout. He received prednisone without improvement. A repeat arthrocentesis was positive for Nocardia farcinica septic arthritis. …

Proteoglycan 4 (Prg4)/Lubricin And The Extracellular Matrix In Gout, Khaled A. Elsaid, Gregory D. Jay, Ru Liu-Bryan, Robert Terkeltaub

Pharmacy Faculty Articles and Research

Proteoglycan 4 (PRG4) is a mucinous glycoprotein secreted by synovial fibroblasts and superficial zone chondrocytes, released into synovial fluid, and adsorbed on cartilage and synovial surfaces. PRG4′s roles include cartilage boundary lubrication, synovial homeostasis, immunomodulation, and suppression of inflammation. Gouty arthritis is mediated by monosodium urate (MSU) crystal phagocytosis by synovial macrophages, with NLRP3 inflammasome activation and IL-1β release. The phagocytic receptor CD44 mediates MSU crystal uptake by macrophages. By binding CD44, PRG4 limits MSU crystal uptake and downstream inflammation. PRG4/CD44 signaling is transduced by protein phosphatase 2A, which inhibits NF-κB, decreases xanthine oxidoreductase (XOR), urate production, and ROS-mediated IL-1β …

Impact Of Dual-Energy Computed Tomography (Dect) Postprocessing Protocols On Detection Of Monosodium Urate (Msu) Deposits In Foot Tendons Of Cadavers, Andrea Sabine Klauser, Sylvia Strobl, Christoph Schwabl, Christian Kremser, Werner Klotz, Violeta Vasilevska Nikodinovska, Hannes Stofferin, Yannick Scharll, Ethan Halpern

Department of Radiology Faculty Papers

Objective: To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. Material and Methods: A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52–99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. …

Sex-Stratified Genetic Analysis Of Gout And Comorbidities, Nicholas Andrew Sumpter

All ETDs from UAB

Gout is a common inflammatory arthritis that is increasing in prevalence globally. It has clear sex differences, being more common among men, though comorbidities appear to be more common among women. It also varies in prevalence between populations, driven by a combination of genetic and socioeconomic factors. Genetic studies have identified gout-associated genetic variants, several of which are shared between different populations. Here, I combined gout-associated genetic variants into a gout polygenic risk score. This score was then used to elucidate the genetic underpinning of gout severity and presence of comorbidities, comparing its effects in different sexes and populations. I …

Lycopodium Clavatum As An Inhibitor Of Monosodium Urate Crystallisation In Gout: An In Vitro Study, Sithara Perveen P, Kr Mansoor Ali, Sheeba Veluthoor, Jijith U.S, Nithya T, Afiya Alloor, Shijil V K

Indian Journal of Research in Homoeopathy

Background: Hyperuricaemia plays a significant role in the development and pathogenesis of several metabolic and systemic disorders including metabolic syndrome, hypertension, stroke and atherosclerosis. Lycopodium clavatum is the most widely used drug in homoeopathy for treating hyperuricaemia and gout. However, its mechanism of action in reducing serum uric acid remains uncertain. Objective: The objective of the study was to study the potential role of homoeopathic preparation of Lycopodium clavatum in different potencies on monosodium urate crystallisation in vitro. Methods: Spectrophotometric crystallisation assay was carried out on a stock solution of 5 ml of uric acid after its …

Protein Phosphatase 2a Regulates Xanthine Oxidase-Derived Ros Production In Macrophages And Influx Of Inflammatory Monocytes In A Murine Gout Model, Sandy Elsayed, Khaled A. Elsaid

Pharmacy Faculty Articles and Research

Background: Gout is a common arthritis, due to deposition of monosodium urate (MSU) crystals which results in IL-1β secretion by tissue-resident macrophages. Xanthine oxidase (XO) catalyzes uric acid (UA) production and in the process, reactive oxygen species (ROS) are generated which contributes to NLRP3 inflammasome activation. Protein phosphatase 2A (PP2A) may be involved in regulating inflammatory pathways in macrophages. The objective of this study was to investigate whether PP2A regulates gout inflammation, mediated by XO activity modulation. We studied UA and ROS generations in MSU stimulated murine bone marrow derived macrophages (BMDMs) in response to fingolimod phosphate, a PP2A activator, …

Carvacrol Alleviates Hyperuricemia-Induced Oxidative Stress And Inflammation By Modulating The Nlrp3/Nf-Κb Pathwayt, Muhammad Riaz, Lina Tariq Al Kury, Noreen Atzaz, Abdullah Alattar, Reem Alshaman, Fawad Ali Shah, Shupeng Li

All Works

Purpose: Gouty arthritis is generally induced by the accumulation of monosodium urate (MSU) crystals in the joints due to elevated serum uric acid levels, potentially leading to serious pathological disorders such as nephrolithiasis, renal failure, and acute gouty arthritis. In this study, we aimed to validate the anti-gout effects of carvacrol, a phenolic monoterpene. Materials and Methods: Male Sprague-Dawley rats were divided into normal saline, disease group by injecting potassium mono-oxonate (PO) at a dose of 250 mg/kg, and three treatment groups, either with carvacrol 20 mg/kg or 50 mg/kg and 10 mg/kg allopurinol. The blood and tissue samples were …

Assessing The Causal Effects Of Adipokines On Uric Acid And Gout: A Two-Sample Mendelian Randomization Study, Ruyi Cong, Xiaoyu Zhang, Zihong Song, Shanshan Chen, Guanhua Liu, Yizhi Liu, Xiuyu Pang, Fang Dong, Weijia Xing, Youxin Wang, Xizhu Xu

Research outputs 2022 to 2026

Previous observational studies have highlighted associations between adipokines and hyperuricemia, as well as gout, but the causality and direction of these associations are not clear. Therefore, we attempted to assess whether there are causal effects of specific adipokines (such as adiponectin (ADP) and soluble leptin receptors (sOB-R)) on uric acid (UA) or gout in a two-sample Mendelian randomization (MR) analysis, based on summary statistics from large genome-wide association studies. The inverse-variance weighted (IVW) method was performed as the primary analysis. Sensitivity analyses (including MR-Egger regression, weighted median, penalized weighted median, and MR pleiotropy residual sum and outlier methods) were also …

Genetic Assessment Of Hyperuricemia And Gout In Asian, Native Hawaiian, And Pacific Islander Subgroups Of Pregnant Women: Biospecimens Repository Cross-Sectional Study, Ali Alghubayshi, Alison Edelman, Khalifa Alrajeh, Youssef Roman

Pharmacotherapy and Outcomes Science Publications

Background

Gout, an inflammatory condition, is characterized by the precipitation of monosodium urate crystals (MSU) in or around distal joints. The latter is caused by chronic hyperuricemia (HU)—high urate levels in the blood. Genetic variations in urate transporters play a significant role in determining urate levels within the human body, rendering some racial and ethnic groups more or less susceptible to developing either HU or gout. This study aims to estimate the frequencies of HU and gout risk alleles in Asian, Native Hawaiian, and Pacific Islander subgroups, using biorepository DNA samples.

Methods

The biospecimens repository at the University of Hawai’i …

Epigenome-Wide Association Study Of Serum Urate Reveals Insights Into Urate Co-Regulation And The Slc2a9 Locus, Adrienne Tin, Pascal Schlosser, Pamela R Matias-Garcia, Chris H L Thio, Roby Joehanes, Hongbo Liu, Zhi Yu, Antoine Weihs, Anselm Hoppmann, Franziska Grundner-Culemann, Josine L Min, Victoria L Halperin Kuhns, Adebowale A Adeyemo, Charles Agyemang, Johan Ärnlöv, Nasir A Aziz, Andrea Baccarelli, Murielle Bochud, Hermann Brenner, Jan Bressler, Monique M B Breteler, Cristian Carmeli, Layal Chaker, Josef Coresh, Tanguy Corre, Adolfo Correa, Simon R Cox, Graciela E Delgado, Kai-Uwe Eckardt, Arif B Ekici, Karlhans Endlich, James S Floyd, Eliza Fraszczyk, Xu Gao, Xīn Gào, Allan C Gelber, Mohsen Ghanbari, Sahar Ghasemi, Christian Gieger, Philip Greenland, Megan L Grove, Sarah E Harris, Gibran Hemani, Peter Henneman, Christian Herder, Steve Horvath, Lifang Hou, Mikko A Hurme, Shih-Jen Hwang, Sharon L R Kardia, Silva Kasela, Marcus E Kleber, Wolfgang Koenig, Jaspal S Kooner, Florian Kronenberg, Brigitte Kühnel, Christine Ladd-Acosta, Terho Lehtimäki, Lars Lind, Dan Liu, Donald M Lloyd-Jones, Stefan Lorkowski, Ake T Lu, Riccardo E Marioni, Winfried März, Daniel L Mccartney, Karlijn A C Meeks, Lili Milani, Pashupati P Mishra, Matthias Nauck, Christoph Nowak, Annette Peters, Holger Prokisch, Bruce M Psaty, Olli T Raitakari, Scott M Ratliff, Alex P Reiner, Ben Schöttker, Joel Schwartz, Sanaz Sedaghat, Jennifer A Smith, Nona Sotoodehnia, Hannah R Stocker, Silvia Stringhini, Johan Sundström, Brenton R Swenson, Joyce B J Van Meurs, Jana V Van Vliet-Ostaptchouk, Andrea Venema, Uwe Völker, Juliane Winkelmann, Bruce H R Wolffenbuttel, Wei Zhao, Yinan Zheng, Marie Loh, Harold Snieder, Melanie Waldenberger, Daniel Levy, Shreeram Akilesh, Owen M Woodward, Katalin Susztak, Alexander Teumer, Anna Köttgen

Student and Faculty Publications

Elevated serum urate levels, a complex trait and major risk factor for incident gout, are correlated with cardiometabolic traits via incompletely understood mechanisms. DNA methylation in whole blood captures genetic and environmental influences and is assessed in transethnic meta-analysis of epigenome-wide association studies (EWAS) of serum urate (discovery, n = 12,474, replication, n = 5522). The 100 replicated, epigenome-wide significant (p < 1.1E-7) CpGs explain 11.6% of the serum urate variance. At SLC2A9, the serum urate locus with the largest effect in genome-wide association studies (GWAS), five CpGs are associated with SLC2A9 gene expression. Four CpGs at SLC2A9 have significant causal effects on serum urate levels and/or gout, and two of these partly mediate the effects of urate-associated GWAS variants. In other genes, including SLC7A11 and PHGDH, 17 urate-associated CpGs are associated with conditions defining metabolic syndrome, suggesting that these CpGs may represent a blood DNA methylation signature of cardiometabolic risk factors. This study demonstrates that EWAS can provide new insights into GWAS loci and the correlation of serum urate with other complex traits.

Storytelling To Improve Disease Outcomes In Gout (Stride-Go): A Multicenter, Randomized Controlled Trial In African American Veterans With Gout, Jasvinder A Singh, Amy Joseph, Joshua Baker, Joshua S Richman, Terrence Shaneyfelt, Kenneth G Saag, Seth Eisen

2020-Current year OA Pubs

BACKGROUND: Urate-lowering therapy (ULT) adherence is low in gout, and few, if any, effective, low-cost, interventions are available. Our objective was to assess if a culturally appropriate gout-storytelling intervention is superior to an attention control for improving gout outcomes in African-Americans (AAs).

METHODS: In a 1-year, multicenter, randomized controlled trial, AA veterans with gout were randomized to gout-storytelling intervention vs. a stress reduction video (attention control group; 1:1 ratio). The primary outcome was ULT adherence measured with MEMSCap™, an electronic monitoring system that objectively measured ULT medication adherence.

RESULTS: The 306 male AA veterans with gout who met the eligibility …

Gout: Current Considerations, Alexandria Fappiano, Wilson Crone

Internet Journal of Allied Health Sciences and Practice

Gout is a treatable chronic inflammatory condition that can cause severe joint pain and disfigurement. Commonly, it affects the first metatarsophalangeal (MTP) joint as a monoarticular process. It is typically caused by hyperuricemia and genetic mutations of the uricase gene. Gout is definitively diagnosed with the presence of negative birefringent needle-shaped crystals in the synovial fluid of the affected joint. Classically, seafood and alcohol are risk factors for developing gout. However, given current population trends, obesity is another major risk factor. While weight loss is the best conservative management, medications can also be used to manage gout. The treatment is …

The Frequency Of Achilles And Plantar Calcaneal Spurs In Gout Patients, Emi̇ne Duran, Emre Bi̇lgi̇n, Ali̇ İhsan Ertenli̇, Umut Kalyoncu

Turkish Journal of Medical Sciences

Background/aim: Gout may cause various radiographic abnormalities such as cartilage loss, spurs, sclerosis, and periostal new bone formation. The purpose of this study was to investigate the frequency of Achilles and plantar spurs and related factors in gout patients. Matherial and methods: We performed a retrospective review of gout patients, treated at Hacettepe University hospitals between 2014 and 2019. We identified patients from the hospital records using the ICD-10 code (M10). Demographic and clinical features, comorbidities, and foot radiographies were collected. The radiographies were evaluated by a rheumatologist (U.K.) who was experienced in musculoskeletal radiography. Factors predicting the spurs were …

Urate Genetic Assessment In Asian And Pacific Islander Subgroups Of Pregnant Women: Implications For Personalized Medicine And Means To Reduce Health Disparities, Ali Alghubayshi

Theses and Dissertations

Gout is one of the most common rheumatic conditions and appears to have a higher prevalence in certain populations. Risk factors for gout and its precursor, hyperuricemia, are also significant risk factors for preeclampsia, major pregnancy-related morbidity. A retrospective cross-sectional study was conducted on 1059 pregnant women from different populations whom 100% reported their ethnicities from the Asian, Native Hawaiian, and Pacific Islander populations. Numerous uric acid (UA) genes and clinical conditions were addressed, and all study details were reviewed and exempted by the University of Hawaii human Studies Program (Protocol Number: 2018-00225). In this project, we hypothesized that UA …

The Impact Of The Illness Label ‘Gout’ On Illness And Treatment Perceptions In Māori (Indigenous New Zealanders), Nicola Dalbeth, Meihana Douglas, Kate Mackrill, Leanne Te Karu, Maria Kleinstäuber, Keith J. Petrie

Psychology Faculty Publications

Background: Despite contemporary advances in understanding pathogenesis and effective management of gout, beliefs about the disease continue to be focused on gout as a self-inflicted illness. The illness label itself may contribute to inaccurate perceptions of the disease and its management. In Aotearoa/New Zealand, Māori (Indigenous New Zealanders) have high prevalence of severe gout. The aim of this study was to examine the impact of the illness label ‘gout’ on perceptions of the disease and its management for Māori. Methods: Māori supermarket shoppers (n = 172) in rural and urban locations were recruited into a study examining the perceptions about …

Design And Biological Evaluation Of Colchicine-Cd44-Targeted Peptide Conjugate In An In Vitro Model Of Crystal Induced Inflammation, Khalid A. Zoghebi, Emira Bousoik, Keykavous Parang, Khaled A. Elsaid

Pharmacy Faculty Articles and Research

Gout is an inflammatory arthritis due to the joint deposition of monosodium urate (MSU) crystals. Phagocytosis of MSU crystals by tissue macrophages results in the generation of reactive oxygen species (ROS) and production of inflammatory cytokines and chemokines. Colchicine use in gout is limited by severe toxicity. CD44 is a transmembrane glycoprotein that is highly expressed in tissue macrophages and may be involved in gout pathogenesis. The P6 peptide is a 20-amino acid residue peptide that binds to CD44. We hypothesized that the conjugation of colchicine to the P6 peptide would reduce its off-target cytotoxicity while preserving its anti-inflammatory effect. …

An Open-Label Prospective Observational Trial For Assessing The Effect Of Homoeopathic Medicines In Patients Suffering From Gout, Sangita Saha, Sarkar Paulami, Rajat Chattopadhyay, Subhranil Saha

Indian Journal of Research in Homoeopathy

Background: Gout is an inflammatory arthritis associated with hyperuricaemia and intra-articular monosodium urate crystals, resulting in pain, activity limitation, disability and impact on patients' quality of life. Objective: The objective of this study was to examine the effects of individualised homoeopathic medicines in serum uric acid level and quality of life in patients suffering from gout. Methods: A prospective, single-arm, non-randomised, open-label, observational trial was conducted on 32 adults suffering from gout (diagnosed as per the American College of Rheumatology–European League Against Rheumatism gout classification criteria) at the Outpatient Department of The Calcutta Homoeopathic Medical College and Hospital, Kolkata. Serum …

Internalized And Anticipated Stigmatization In Patients With Gout, Maria Kleinstäuber, Leonie Wolf, Annie S. K. Jones, Nicola Dalberth, Keith J. Petrie

Psychology Faculty Publications

Objective: To investigate the relationship between stigma perception and demographic, clinical, and psychosocial variables. Methods: A sample of 50 patients with gout and prescribed urate-lowering medication (84% were males, mean serum urate 0.34 mmol/l) completed questionnaires on internalized and anticipated stigma, demographics, clinical gout-related variables, and psychosocial variables (illness perceptions, illness-related disability, illness-related body satisfaction, intentional nonadherence). Serum urate level was obtained from the most recent blood test. Results: In this sample, 26% experienced internalized stigma, 26% expected to be stigmatized by friends or family members, and 14% by health care workers. Univariate regression analyses showed that younger age, ethnicity …

Gouty Arthritis, Erin Dutt

Nursing Student Class Projects (Formerly MSN)

Gout is an arthritic condition that can lead to destruction of the affected joints. Often the main complaint is severe pain of the big toe but could affect other joints. Due to the frequency of this condition, the family nurse practitioner (FNP) could easily encounter it in family practice. What causes the joint destruction is the deposit monosodium urate crystals (MSU) along a joint due to hyperuricemia. Not only can gout cause permanent joint damage, it also increases the risk for kidney damage. Treatment will be aimed at managing acute attacks and lowering serum uric acid (SUA) levels. Controlling modifiable …

Assessment Of Sensitivity And Specificity Of Ultrasonographic Features Of Gout In Intercritical And Chronic Phases, Abeer H. Ismaiel, Mohamed A. Safy, Nisreen H. Mohmoud, Tamer A. Aboul-Sood El-Kassas

Journal of Medicine in Scientific Research

Aim To study the usefulness of ultrasonography (US) in the diagnosis of gouty arthritis and to assess its sensitivity and specificity in intercritical and chronic stages and also its use in comparing patients with high serum uric acid (HSUA) and low serum uric acid (LSUA). Patients and methods We studied 60 patients known to be gouty in either chronic phase or intercritical phase, diagnosed clinically and through laboratory assessments, and 30 controls. Demographic, clinical, and serological data were evaluated. Knee and first metatarsophalangeal joints were assessed by musculoskeletal US by a blinded radiologist. Results A total of 53 (88.3%) patients …

Cardiovascular Safety Of Febuxostat And Allopurinol In Gout/Hyperuricemia Patients: A Retrospective Cohort Event Reporting In A Tertiary Healthcare Facility, Sonal M. Sekhar Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: On February 21st 2019, FDA added a boxed warning for increased risk of death with febuxostat compared to allopurinol. Purpose: To compare the incidence of cardiovascular events and efficacy between febuxostat and allopurinol use. Methods: A retrospective cohort study was conducted in hyperuricemic/gout patients admitted between 2013 to 2017. Study cohort (febuxostat/allopurinol/both) and control cohort (drugs other than febuxostat/allopurinol) were selected based on inclusion and exclusion criteria. The primary outcomes were various cardiovascular events which were compared and analysed using IBM SPSS version 20 and p<0.05 was considered statistically significant. Results: Mean reduction in level of serum urate after febuxostat and allopurinol use was 2.754 mg/dl [p=0.000; CI (95%) 2.209-3.299] and 1.137 mg/dl [p=0.000; CI (95%) 0.792-1.482], respectively. However, there was no statistically significant difference between the groups. The mean survival time for febuxostat was 37 months [CI (95%) 24-51], whereas for allopurinol was 107 months [CI (95%) 52-162] and for both users was 38 months [CI (95%) 20-56]. However, there was no significant difference among the groups (p=0.762). Cardiovascular events occurred in 4 (5.63%) patients in febuxostat group (n=71), 6 (6.45%) patients in allopurinol group (n=93) and 3 (30%) patients in group with both drugs (n=10). The number needed to harm (NNH) for febuxostat, allopurinol and with both drugs were 22, 19 and 3, respectively. Conclusion: Both febuxostat and allopurinol are significantly efficacious in reducing serum urate levels. Lesser mean survival time in febuxostat group indicates faster occurrence of cardiovascular events. On the other hand, incidence of cardiovascular events was more with allopurinol than febuxostat without statistical significance. We observed these cardiovascular adverse events of allopurinol and febuxostat are duration depended.

Caspase-11 Mediates Neutrophil Chemotaxis And Extracellular Trap Formation During Acute Gouty Arthritis Through Alteration Of Cofilin Phosphorylation, Kyle Caution, Nicholas Young, Frank Robledo-Avila, Kathrin Krause, Arwa Abu Khweek, Kaitlin Hamilton, Asmaa Badr, Anup Vaidya, Kylene Daily, Hawin Gosu, Midhun N. K. Anne, Mostafa Eltobgy, Duaa Dakhlallah, Sudha Argwal, Shady Estfanous, Xiaoli Zhang, Santiago Partida-Sanchez, Mikhail A. Gavrilin, Wael N. Jarjour, Amal O. Amer

Faculty & Staff Scholarship

Gout is characterized by attacks of arthritis with hyperuricemia and monosodium urate (MSU) crystal-induced inflammation within joints. Innate immune responses are the primary drivers for tissue destruction and inflammation in gout. MSU crystals engage the Nlrp3 inflammasome, leading to the activation of caspase-1 and production of IL-1β and IL-18 within gout-affected joints, promoting the influx of neutrophils and monocytes. Here, we show that caspase-11−/− mice and their derived macrophages produce significantly reduced levels of gout-specific cytokines including IL-1β, TNFα, IL-6, and KC, while others like IFNγ and IL-12p70 are not altered. IL-1β induces the expression of caspase-11 in an IL-1 …

Diagnosis And Long-Term Management Of Uromodulin Kidney Disease, Emily Wheeler, Suresh Thomas

Faculty & Staff Scholarship

Uromodulin kidney disease (UKD) is a subtype of autosomal dominant tubulointerstitial kidney disease (ADTKD), and is a rare cause of renal failure and gout in young people. Although it is inherited in an autosomal dominant fashion, the gene mutation exhibits variable expressivity so the phenotype varies dramatically among affected individuals. While it is rare, it is important for physicians in the primary care setting to be able to recognize the disorder, initiate proper workup, and refer patients to nephrology teams that are equipped to manage the long-term needs of these patients. Eventually, most will progress to renal failure with necessary …

Are Oral Steroids As Effective As Nsaids In Relieving Patient Pain From Gout?, Haley T. Peeples

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is the determine whether or not, “oral steroids are as effective as NSAIDS in relieving patient pain from gout?”

STUDY DESIGN: Review of three English language primary studies, published between 2008 and 2016.

DATA SOURCES: Three randomized controlled trials (RCTs) were found using PubMed and Embase database. These studies analyzed the effectiveness of steroids in relieving patient pain from gout.

OUTCOMES MEASURED: The major outcomes measured were improvements in joint tenderness on palpation, joint erythema, joint swelling, and joint activity measured on a 5-point Likert scale. (0=no pain, 1=mild pain, 2=moderate pain, …

Implementation Of The 2012 American College Of Rheumatology Guidelines For Management Of Gout In A Sample Of Midwestern Native Americans, Myrth C. Condon

DNP Scholarly Projects

Gout is a well understood, yet poorly treated condition that is associated with many co-morbidities including hypertension, renal and cardiac disease, metabolic syndrome, central obesity and type-2 diabetes. The American Indian population is at risk for gout due an increased incidence of type-2 diabetes, chronic kidney disease, hypertension, and alcohol abuse. The purpose of this scholarly project was to implement the 2012 American College of Rheumatology (ACR) guidelines in a sample of Tribal members within mid-western portions of the United States. This scholarly project utilized a quasi-experimental research design with pretest – posttest methods to measure uric acid levels at …

Moderating Effects Of Immunosuppressive Medications And Risk Factors For Post-Operative Joint Infection Following Total Joint Arthroplasty In Patients With Rheumatoid Arthritis Or Osteoarthritis, Elizabeth G. Salt, Amanda T. Wiggins, Mary Kay Rayens, Brent J. Morris, David M. Mannino, Andrew Hoellein, Ryan P. Donegan, Leslie J. Crofford

Nursing Faculty Publications

Objective—Inconclusive findings about infection risks, importantly the use of immunosuppressive medications, in patients who have undergone large-joint total joint arthroplasty challenge efforts to provide evidenced-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a postoperative infection in patients undergoing TJA of a large joint [total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty] by identifying clinical and demographic factors, including the use of high risk medications (i.e., prednisone and immunosuppressive medications) and diagnoses (i.e., rheumatoid arthritis [RA], osteoarthritis [OA], gout, obesity, diabetes mellitus), that …

Role Of Dual Energy Computed Tomography Imaging In The Diagnosis Of Gout, Divya Jayakumar, S Sehra, S Anand, Gary Stallings, A Danve

NYMC Faculty Publications

Gout is a well-known inflammatory arthritis and affects four percent of the United States population. It results from the deposition of uric acid crystals in joints, tendons, bursae, and other surrounding tissues. Prevalence of gout has increased in the recent decade. Gout is usually seen in conjunction with other chronic comorbid conditions like cardiac disease, metabolic syndrome, and renal disease. The diagnosis of this inflammatory arthritis is confirmed by visualization of monosodium urate (MSU) crystals in the synovial fluid. Though synovial fluid aspiration is the standard of care, it is often deferred because of inaccessibility of small joints, patient assessment …

The Effects Of Super-Fruits Including Montmorency Tart Cherries And Pomegranate On The Human Body: A Literature Review, Keeley D. Forrester

Senior Honors Theses and Projects

This literature review explores several published articles that report results related to health benefits of super-fruits including Montmorency tart cherries and pomegranate. Research suggests that Montmorency tart cherry supplementation may have the ability to relieve pain by decreasing inflammation, prevent gout flare ups by reducing uric acid levels in the bloodstream, relieve insomnia with natural exogenous melatonin, and lessen symptoms of muscle damage from physical exertion by decreasing oxidative stress. Studies have also shown that pomegranate supplementation may have the ability to help prevent obesity by helping to decrease body weight and fat production and improving insulin sensitivity as well …

Gout Patient Interview And Physical Examination, Michele Meltzer, Md, Mbe

Michele Meltzer

Although the incidence of gout is increasing worldwide, there are many misconceptions about the diagnosis and treatment of gout. The two attached videos can be used to inform medical students, residents in family practice, internal medicine, orthopedic surgery, emergency medicine, psychiatry residents as well as practicing physicians about gout. Allied health professionals including nurses, nurse practitioners and physicians assistants will also find the videos helpful.

In the first video I interview and exam a patient with gout. This scenario is used to describe how to obtain a history and synthesize a differential diagnosis. As I exam the patient, I describe …

Gout: Diagnosis And Treatment, Michele Meltzer, Md, Mbe

Michele Meltzer

Although the incidence of gout is increasing worldwide, there are many misconceptions about the diagnosis and treatment of gout. The two attached videos can be used to inform medical students, residents in family practice, internal medicine, orthopedic surgery, emergency medicine, psychiatry residents as well as practicing physicians about gout. Allied health professionals including nurses, nurse practitioners and physicians assistants will also find the videos helpful. The second video I review the causes of gout and show several pictures to demonstrate what an acute attack can look like. The recommendations for the diagnosis and treatment of gout are reviewed. At the …