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Diagnosis of Intercritical Gout
- Eliseo Pascual, MD, PhD;
- Enrique Batlle-Gualda, MD, PhD; and
- Agustín Martínez, MD
- 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)
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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).
Eliseo Pascual, MD, PhD
Hospital General Universitario de Alicante; Alicante, Spain 03010
Enrique Batlle-Gualda, MD, PhD
Hospital General Universitario de Alicante; Alicante, Spain 03010
Agustín Martínez, MD
Hospital General Universitario de Alicante; Alicante, Spain 03010
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
