Document Detail

Acute gouty synovitis associated with "urate milk".
MedLine Citation:
PMID:  9415648     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To analyze the clinical features of acute gouty synovitis associated with thick, milky white, "chalky," urate laden synovial effusions, and to investigate the effects on synovial white blood cell (WBC) counts when leukocyte-rich rheumatoid effusions are incubated with a urate packed milky synovial fluid. METHODS: Five patients (all men, mean age 70.8 years) with acute gouty synovitis (acute arthritis in 3, acute bursitis in 2) associated with "urate milk" were studied between 1993 and 1996. RESULTS: Synovial effusions were thick, "chalky," and appeared "milky" white. The fluids were packed with monosodium urate (MSU) crystals, which sedimented upon standing, leaving a clear supernatant containing a few MSU crystals. The presence of massive amounts of MSU crystals and crystal clumps interfered with accurate determination of synovial WBC counts. Four fluids showed "a few leukocytes," and one a WBC count of 6750/mm3 with 91% neutrophils and several intraleukocytic crystals. Four patients had subcutaneous tophi. Of the risk factors associated with development of gout, the most frequent was ethanol abuse, in 4 and possibly all 5 patients. Incubation of leukocyte-rich rheumatoid synovial effusions with urate laden knee fluid from Patient 5 produced a greater reduction in synovial WBC counts compared to controls. CONCLUSION: Milky white synovial effusions containing massive quantities of urate crystals (referred to as "urate milk") may rarely occur in the setting of acute gouty arthritis or bursitis. Ethanol abuse appears to be a risk factor associated with the development of hyperuricemia and gout in these patients.
A G Fam; M D Reis; J P Szalai
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of rheumatology     Volume:  24     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-02-05     Completed Date:  1998-02-05     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  2389-93     Citation Subset:  IM    
Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
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MeSH Terms
Aged, 80 and over
Antirheumatic Agents / therapeutic use
Arthritis, Gouty / drug therapy,  epidemiology,  metabolism*
Bursitis / metabolism
Exudates and Transudates / chemistry
Leukocyte Count
Risk Factors
Synovial Fluid / chemistry*,  cytology
Synovitis / metabolism*
Treatment Outcome
Uric Acid / analysis*,  chemistry
Reg. No./Substance:
0/Antirheumatic Agents; 69-93-2/Uric Acid
Comment In:
J Rheumatol. 1998 Nov;25(11):2285-6   [PMID:  9818683 ]

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