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Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout.
Ann Rheum Dis. 2007 Aug; 66(8):1056-8.AR

Abstract

OBJECTIVES

To determine whether hypouricaemic treatment results in the disappearance of urate crystals from gouty joints and to define the time required.

METHODS

In 18 patients with monosodium urate (MSU) crystal proven gout, and after the initiation of successful serum uric acid (SUA)-lowering treatment, an arthrocentesis of the asymptomatic signal joint (11 knees, 7 first metatarsophalangeal joints) was performed every 3 months to obtain a synovial fluid (SF) sample. The sample was then analysed for the presence of MSU crystals, and the number of crystals/400x field was noted. SUA levels and the duration of gout were also noted.

RESULTS

MSU crystals disappeared from the SF of all 18 joints after reduction of SUA to normal levels. The time required for disappearance ranged from 3 to 33 months; disappearance time correlated with the duration of gout (r(s) = 0.71; p<0.01). The median number of MSU crystals in the SF samples before urate-lowering treatment was 7.5 (2.5-11) crystals/400x field, reducing to 3 (1-6.5) crystals/400x field (p<0.05) at 3 months. Crystal counts continued to decrease after 3 months.

CONCLUSIONS

In gout, reduction of SUA to normal levels results in disappearance of urate crystals from SF, requiring a longer time in those patients with gout of longer duration. This indicates that urate crystal deposition in joints is reversible. Normalisation of SUA levels results in a decrease in the concentration of MSU crystals in SF in the asymptomatic gouty joints. This may partially explain the reduced frequency of gouty attacks when a patient has been treated with SUA-lowering drugs.

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Authors+Show Affiliations

Pascual E
Catedrático de Medicina (Reumatología), Hospital General Universitario de Alicante, Maestro Alonso 109, 03010 Alicante, Spain. pascual_eli@gva.es
Sivera F
No affiliation info available

MeSH

AdultAgedBenzbromaroneChronic DiseaseCrystallizationFollow-Up StudiesGoutGout SuppressantsHumansKnee JointMaleMetatarsophalangeal JointMiddle AgedStatistics, NonparametricSynovial FluidTime FactorsTreatment OutcomeUric Acid

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17223663

Citation

Pascual, Eliseo, and Francisca Sivera. "Time Required for Disappearance of Urate Crystals From Synovial Fluid After Successful Hypouricaemic Treatment Relates to the Duration of Gout." Annals of the Rheumatic Diseases, vol. 66, no. 8, 2007, pp. 1056-8.
Pascual E, Sivera F. Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout. Ann Rheum Dis. 2007;66(8):1056-8.
Pascual, E., & Sivera, F. (2007). Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout. Annals of the Rheumatic Diseases, 66(8), 1056-8.
Pascual E, Sivera F. Time Required for Disappearance of Urate Crystals From Synovial Fluid After Successful Hypouricaemic Treatment Relates to the Duration of Gout. Ann Rheum Dis. 2007;66(8):1056-8. PubMed PMID: 17223663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout. AU - Pascual,Eliseo, AU - Sivera,Francisca, Y1 - 2007/01/12/ PY - 2007/1/16/pubmed PY - 2007/9/11/medline PY - 2007/1/16/entrez SP - 1056 EP - 8 JF - Annals of the rheumatic diseases JO - Ann Rheum Dis VL - 66 IS - 8 N2 - OBJECTIVES: To determine whether hypouricaemic treatment results in the disappearance of urate crystals from gouty joints and to define the time required. METHODS: In 18 patients with monosodium urate (MSU) crystal proven gout, and after the initiation of successful serum uric acid (SUA)-lowering treatment, an arthrocentesis of the asymptomatic signal joint (11 knees, 7 first metatarsophalangeal joints) was performed every 3 months to obtain a synovial fluid (SF) sample. The sample was then analysed for the presence of MSU crystals, and the number of crystals/400x field was noted. SUA levels and the duration of gout were also noted. RESULTS: MSU crystals disappeared from the SF of all 18 joints after reduction of SUA to normal levels. The time required for disappearance ranged from 3 to 33 months; disappearance time correlated with the duration of gout (r(s) = 0.71; p<0.01). The median number of MSU crystals in the SF samples before urate-lowering treatment was 7.5 (2.5-11) crystals/400x field, reducing to 3 (1-6.5) crystals/400x field (p<0.05) at 3 months. Crystal counts continued to decrease after 3 months. CONCLUSIONS: In gout, reduction of SUA to normal levels results in disappearance of urate crystals from SF, requiring a longer time in those patients with gout of longer duration. This indicates that urate crystal deposition in joints is reversible. Normalisation of SUA levels results in a decrease in the concentration of MSU crystals in SF in the asymptomatic gouty joints. This may partially explain the reduced frequency of gouty attacks when a patient has been treated with SUA-lowering drugs. SN - 0003-4967 UR - https://www.unboundmedicine.com/medline/citation/17223663/Time_required_for_disappearance_of_urate_crystals_from_synovial_fluid_after_successful_hypouricaemic_treatment_relates_to_the_duration_of_gout_ L2 - https://ard.bmj.com/lookup/pmidlookup?view=long&amp;pmid=17223663 DB - PRIME DP - Unbound Medicine ER -