Faculty Bibliography

Gout is characterized by the deposition of monosodium urate crystals and by acute and chronic inflammation in response to crystals so deposited. Multiple case reports and series describe the deposition of monosodium urate in the spine as a rare manifestation of gout, but the actual prevalence of spinal involvement is unknown and likely to be higher than generally anticipated. Here we review the characteristics of 131 previously reported cases of spinal involvement in gout. We focus in particular on the use of imaging modalities and the extent to which they correlate with presenting symptoms and tissue diagnoses. The recent innovation of using dual-energy computerized tomography to identify urate crystal deposition holds promise for reducing the need for surgical intervention and for establishing a true prevalence rate for spinal gout.

Background/Purpose: Osteoarthritis (OA) and gout are each associated with increased cardiovascular disease (CVD), but their relative impacts on CV risk are not known. We compared rates of CVD among patients with OA (OA-only), gout (gout-only), or both (gout+OA). Methods: We used ICD-9 codes to identify male patients from within our VA health care system with OA-only, goutonly, or gout+OA, and an active medical record between August 2007 and August 2008. For each group, we collected baseline demographics and CVD risk factors. The primary outcome was a composite index (CV4) consisting of any diagnosis of myocardial infarction (MI), angina, coronary bypass surgery (CABG), and/or coronary artery disease (CAD). Secondary outcomes included individual diagnoses within the CV4, congestive heart failure (CHF) and death. Logistic regression was used to compare the associations of OA-only, gout-only, and gout+OA with CV outcomes, adjusting for traditional CV risk factors: age, race, hypertension (HTN), diabetes mellitus, hyperlipidemia (HLD), chronic kidney disease (CKD), and smoking. Results: 1280 gout subjects met inclusion criteria (983 gout-only, 297 gout+OA), along with 1231 OA-only subjects. Gout subjects, with or without OA, had more CVD risk factors at baseline, including HTN, HLD and CKD vs. OA-only. In an unadjusted model, a diagnosis of gout increased the risk for CV4, CAD, angina, CABG, CHF, and death compared to a diagnosis of OA-only. In a fully adjusted model, gout-only subjects continued to have increased risk for all outcomes except MI and death compared to OA-only subjects, while gout+OA subjects exhibited increased risk for angina and CHF (Table 1). Gout+OA did not impart additional risk over gout-only for any outcome except CABG. Conclusion: Our data suggest that gout is associated with higher risk of CVD compared with OA, that at least some of this increased risk may be independent of traditional risk factors, and that OA does not impart additive CVD risk to patients who also have gout. (Table Presented)

Although colchicine has been a focus of research, debate and controversy for thousands of years, it was only approved by the United States Food and Drug Administration in 2009. Over the past decade, advances in the knowledge of colchicine pharmacology, drug safety and mechanisms of action have led to changes in colchicine dosing and to potential new uses for this very old drug. In this review, we discuss the pharmacologic properties of colchicine and summarize what is currently known about its mechanisms of action. We then discuss and update the use of colchicine in a variety of illnesses, including rheumatic and, most recently cardiovascular diseases.

BACKGROUND: Gout and osteoarthritis (OA) are the most prevalent arthritides, but their relationship is neither well established nor well understood. OBJECTIVES: We assessed whether a diagnosis of gout or asymptomatic hyperuricemia (AH) is associated with increased prevalence/severity of knee OA. METHODS: One hundred nineteen male patients aged 55 to 85 years were sequentially enrolled from the primary care clinics of an urban Veterans Affairs hospital, assessed and categorized into 3 groups: gout (American College of Rheumatology Classification Criteria), AH (serum urate >/=6.8 mg/dL, no gout), and control (serum urate <6.8 mg/dL, no gout). Twenty-five patients from each group subsequently underwent formal assessment of knee OA presence and severity (American College of Rheumatology Clinical/Radiographic Criteria, Kellgren-Lawrence grade). Musculoskeletal ultrasound was used to detect monosodium urate deposition at the knees and first metatarsophalangeal joints. RESULTS: The study showed 68.0% of gout, 52.0% of AH, and 28.0% of age-matched control subjects had knee OA (gout vs control, P = 0.017). Odds ratio for knee OA in gout versus control subjects was 5.46 prior to and 3.80 after adjusting for body mass index. Gout subjects also had higher Kellgren-Lawrence grades than did the control subjects (P = 0.001). Subjects with sonographically detected monosodium urate crystal deposition on cartilage were more likely to have OA than those without (60.0 vs 27.5%, P = 0.037), with crystal deposition at the first metatarsophalangeal joints correlating most closely with OA knee involvement. CONCLUSIONS: Knee OA was more prevalent in gout patients versus control subjects and intermediate in AH. Knee OA was more severe in gout patients versus control subjects.