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REPLY
Diagnosis of Intercritical Gout
Eliseo Pascual, MD, PhD;
Enrique Batlle-Gualda, MD, PhD; and
Agustín Martínez, MD
16 May 2000 | Volume 132 Issue 10 | Page 843
IN RESPONSE:
Dr. Johnson's point is accurate and pertinent. Our data indicate that after monosodium urate crystals form, they stay indefinitely in the joint (and for diagnostic purposes can be found in synovial fluid samples) as long as hyperuricemia persists. Furthermore, during intercritical periods, in these gouty joints there is an intense interaction between crystals and cells, as shown by the regular finding of cells with phagocyted monosodium urate crystals in synovial fluid samples drawn from these joints (1). The higher than normal leukocyte counts in these same synovial fluid samples (2), which decrease after low-dose colchicine prophylaxis (3), indicate that during the intercritical periods these joints maintain some degree of subclinical inflammation related to monosodium urate crystals. It is on this background that gout attacks occur.
Certainly, other joint diseases (such as infection, as suggested by Dr. Johnson) may also occur. When the clinical features suggest the possibility of joint infection despite the presence of monosodium urate crystals in the synovial fluid, appropriate synovial fluid cultures must be done (4). However, because the most common type of acute arthritis in gouty joints is gouty arthritis, culturing all synovial fluid samples that contain monosodium urate crystals appears inappropriate. Of additional interest, the mild crystal-related subclinical inflammation maintained by gouty joints could modify the presentation of other diseases that could develop concurrently in the same joints; in this respect, it is of interest that rheumatoid arthritis and gout rarely coexist. A negative association between these two conditions has been reported (5).
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Author and Article Information
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Hospital General Universitario de Alicante; Alicante, Spain 03010 (Pascual)
Hospital General Universitario de Alicante; Alicante, Spain 03010 (Batlle-Gualda)
Hospital General Universitario de Alicante; Alicante, Spain 03010 (Martínez)
1. Pascual E, Jovaní V. A quantitative study of the phagocytosis of urate crystals in the synovial fluid of asymptomatic joints of patients with gout Br J Rheumatol. 1995;34:724-6.[Abstract/Free Full Text]
2. Pascual E. Persistence of monosodium urate crystals, and low grade inflammation, in the synovial fluid of untreated gout Arthritis Rheum. 1991;34:141-5.[Medline]
3. Pascual E, Castellano JA. Treatment with colchicine decreases the white cell counts in the synovial fluid of asymptomatic knees which contain monosodium urate crystals J Rheumatol. 1992;19:600-3.[Medline]
4. Baker DG, Schumacher HR. Acute monoarthritis N Engl J Med. 1993;329:1013-20.[Free Full Text]
5. Schapira D, Stahl S, Izhak OB, Balbir-Gurman A, Nahir AM. Chronic tophaceous gout mimicking rheumatoid arthritis Semin Arthritis Rheum. 1999;29:56-63.[Medline]
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Brief Communications
Synovial Fluid Analysis for Diagnosis of Intercritical Gout
Eliseo Pascual, Enrique Batlle-Gualda, Agustín Martínez, José Rosas, AND Paloma Vela
- Annals 1999 131: 756-759.
[ABSTRACT][SUMMARY][Full Text]
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