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Monday, 25 April 2016

Most Common Disease of 50+: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - The Misdiagnosis and delay diagnosis

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.

           The Misdiagnosis and delay diagnosis

According to the University of Kansas School of Medicine, out of 9,108 consecutive new patients seen in an outpatient rheumatology clinic, 155 (1.7%) diagnosed as having gout, 164 (1.8%) had been incorrectly diagnosed as having gout in the community(131).
"The main factors potentially contributing to delayed diagnosis after consultation included reported misdiagnosis, attacks in joints other than the first metatarsophalangeal joint, and female gender. The limitations in using serum uric acid (SUA) levels for diagnostic purposes were not always communicated effectively to patients, and led to uncertainty and lack of confidence in the accuracy of the diagnosis", the Keele University insisted(134).

1. Rheumatoid arthritis
In elderly, polyarticular gout may be misdiagnosed due to confusing clinical presentation of "diuretic gout" such as polyarticular onset, subacute symptoms. ......According to the Albert Einstein College of Medicine, misdiagnosis of rheumatoid arthritis can induce poor treatment of gout, affecting underlying conditions of renal insufficiency, and cardiac risks(132).

2. Elderly-onset gout (EOG)
Elderly-onset gout (EOG) is a condition of gout with onset at age 65 years or over, shared a relevant epidemiological, clinical and therapeutic differences from the typical middle-age form. According to the University of Ferrara,"EOG has recently been confirmed as the most common inflammatory arthropathy in older people, with important demographic implications and substantial impact on daily clinical practice. Despite the high prevalence, gout, in the elderly, often remains misdiagnosed or diagnosed late in its clinical course."(133).

3. Misdiagnosis due to confusing in classification
According to the Hospital Universitario Cruces, as a step-up disease, gout consists different stages: acute gout, intercritical gout, and chronic gout but in clinical practice, gout should be considered as a single disease with either or both acute (most commonly, episodes of acute inflammation) but not restricted to chronic synovitis in support the clinical manifestations and diagnosis of gout(135).

4. Recurrent gouty arthritis
There is a report of misdiagnosis of recurrent gouty arthritis associated with hyperuricemia and hyperlipidemia during adolescence. as steatohepatitis in a family with mild glycogen storage disease type 1a. National Chung Hsing University, due to the effect of result of misdiagnosis suggested that patients with mild glycogen storage disease should be considered in the adolescents with unexplained hyperuricemia and hyperlipidemia, despite the presence of normal blood glucose levels(136).

5. Chylous cysts of the neck or chest
According to the Geisinger Medical Center, there is a report of chylous cyst was misdiagnosed as recurrent chest wall gouty tophus due to form birefringent crystals upon drying(137).

6. Psoriatic arthritis
In the review of Forty-two patients with psoriatic arthritis who were referred to a tertiary medical center from 1983 to 1987, eight patients with foot and ankle involvement were diagnosed and treated for either gout or compression of a digital nerve due to failure to identify psoriatic skin lesions and the  associate foot and ankle symptoms with psoriatic arthritis.(138).

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References
(130) Dual-Energy Computed Tomography: Advantages in the Acute Setting by McLaughlin PD1, Mallinson P2, Lourenco P2, Nicolaou S2.(PubMed)
(131) The misdiagnosis of gout and hyperuricemia by Wolfe F1, Cathey MA.(PubMed)
(132) Misdiagnosis of rheumatoid arthritis in an elderly woman with gout by Sewell KL1, Petrucci R, Keiser HD.(PubMed)
(133) Elderly-onset gout: a review. by De Leonardis F1, Govoni M, Colina M, Bruschi M, Trotta F.(PubMed)
(134) Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration. by Liddle J1, Roddy E1, Mallen CD1, Hider SL1, Prinjha S2, Ziebland S2, Richardson JC1.(PubMed)
(135) Clinical manifestations and diagnosis of gout by Perez-Ruiz F1, Castillo E2, Chinchilla SP2, Herrero-Beites AM3.(PubMed)
(136) Misdiagnosis as steatohepatitis in a family with mild glycogen storage disease type 1a by Shieh JJ1, Lu YH, Huang SW, Huang YH, Sun CH, Chiou HJ, Liu C, Lo MY, Lin CY, Niu DM.(PubMed)
(137) Misdiagnosis of a chylous cyst as chest wall gouty tophus: a case of true pseudogout by Adhikesavan LG1, Ayoub WT, Schumacher HR.(PubMed)
(138) Psoriatic arthritis of the foot and ankle: analysis of joint involvement and diagnostic errors by Hammerschlag WA1, Rice JR, Caldwell DS, Goldner JL.(PubMed)