title: Severe tophaceous gout. Characterization of low socioeconomic level patients from México.
abstract: OBJECTIVE
  To describe a group of patients with frequent tophaceous gout, the variables associated with severe tophaceous gout and to compare them with other patients with gout described elsewhere.
  
  
  METHODS
  We looked for 65 demographic clinical and paraclinical variables from patients with gout who attended our gout clinic from 1995-2000 and were evaluated by the same group of physicians.
  
  
  RESULTS
  Three hundred and sixteen patients were included, 98% males, 82% live in México city, the mean age at onset, educational level and disease duration were 37.5 +/- 12.4, 6.3 +/- 3.9 and 12.6 +/- 10.3 years respectively. Tophaceous gout was present in 62% of the patients with a mean tophi number of 4.7 +/- 6.3 and mean HAQ score 0.13 +/- 0.37. Severe tophaceous gout (>or= 5 tophi) was found in 34% and these patients had significantly: earlier age at onset, longer duration of the disease, lesser frequency of obesity and higher frequency of: intradermal tophi, HAQ > 0.5, hospitalizations, radiographic score III/IV, uric acid under-excretion, renal function impairment and previous (oral and parenteral) auto-prescribed chronic glucocorticoid treatment compared with patients with non-severe tophaceous gout. In the multiple logistic regression the significant variables were renal function impairment (p = 0.000) and previous chronic parenteral glucocorticoid treatment (p = 0.011) .
  
  
  CONCLUSIONS
  Our patients compared with those from other countries who have earlier age at onset, very low frequency of gout among females, frequent tophaceous gout and severe tophaceous gout. Severe tophaceous gout in this group is associated with renal function impairment and previous chronic parenteral glucocorticoid treatment.
authors.affiliation: Rheumatology Service, Hospital General de México, Facultad de Medicina, Universidad Nacional Autónoma de México. jvazquezmellado@prodigy.net.mx
authors.forename: J
authors.initials: J
authors.lastname: Vázquez-Mellado
authors.forename: J
authors.initials: J
authors.lastname: Cruz
authors.forename: S
authors.initials: S
authors.lastname: Guzmán
authors.forename: J
authors.initials: J
authors.lastname: Casasola-Vargas
authors.forename: L
authors.initials: L
authors.lastname: Lino
authors.forename: R
authors.initials: R
authors.lastname: Burgos-Vargas
mesh_terms: D000328:Adult; D017668:Age of Onset; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006073:Gout / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids