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- W1978336184 abstract "A 56-year-old Brazilian man, non-alcoholic, with no family history of arthritis, complained of weight loss and fever during haemodialysis. Over the previous 3 years he had asymmetric podagra responsive to colchicine and allopurinol, and developed subcutaneous nodules in fingers and forearms, where tophi of monosodium urate crystals were found on needle aspiration. He also had recurrent symmetric polyarthritis in wrists and hands without morning stiffness. On admission his temperature was 36.5°C. The heart was rhythmic at 99 beats per minute and blood pressure 190/110 mmHg. The lungs were clear and respiratory rate 20 incursions per minute. The liver was normal and the spleen was enlarged. Symmetric nodules were found in the third proximal interphalangeal hand joints (Figure 1) and near the elbows (Figure 2) without rheumatoid deformities. The results of blood tests were as follows: erythrocytes 2.77×106/mm3, haemoglobin 8.1g/dl, haematocrit 25.9%, leukocytes 13 100/mm3 (neutrophils 72%, lymphocytes 20%), platelets 280 000/mm3, erythrocyte sedimentation rate 89 mm/hr, albumin 3.6 g/dl, globulins 4.8 g/dl, Bence-Jones proteinuria negative, uric acid 11.3 mg/dl, iron 57 μg/dl, glucose 84 mg/dl, urea 93 mg/dl, creatinine 8.4 mg/dl, sodium 135 mEq/litre, potassium 4.8 mEq/litre, calcium 1.44 mmol/litre, phosphorus 5.3mg/dl, aspartate transaminase 20U/litre, alanine transaminase 33U/litre, gamma-glutamyl transpeptidase 170 UI/litre, triglycerides 101 mg/dl, cholesterol 117 mg/dl. C-reactive protein 4.8 mg/dl, acid alpha1-glycoprotein 235 mg/dl, rheumatoid factor 82.3 UI/dl, antinuclear, anti-DNA, and anti-microsomal antibodies negative. Complement levels were C3 116 mg/dl and C4 55 mg/dl. Tests for hepatitis C and toxoplasmosis immunoglobulin G were positive; and hepatitis B, brucellosis, mononucleosis, syphilis and human immunodeficiency virus were negative. Radiograph of hands showed cortical erosions in the third proximal interphalangeal joints, with normal joint spaces, erosions and cysts in metacarpal epiphyses, with symmetrical periarticular osteoporosis and soft tissue swelling (Figure 3). Medial epicondyle erosion with overhanging edges and fluffy calcifications of chronic tophaceous gout (Monu and Pope, 2004) were seen in the left olecranon. Biopsy of subcutaneous nodule disclosed granulomas with central zones of fibrinoid necrosis surrounded by palisades of mononuclear cells (Figures 4 and 5), and characterized rheumatoid arthritis coexistent with gout." @default.
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- W1978336184 date "2005-12-01" @default.
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- W1978336184 title "Coexistent gout and rheumatoid arthritis: a case report" @default.
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- W1978336184 doi "https://doi.org/10.12968/hmed.2005.66.12.20214" @default.
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