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Article ; Online: A rare case of smear positive tuberculous arthritis.

Sureshkumar, Mathavi / Rajamani, Shanmugasundaram / Ravindran, Vijayaragavan / ArvindhKrishnan, E

Indian journal of pathology & microbiology

2023 Volume 66, Issue 2, Page(s) 350–351

Abstract: TB arthritis is a very rare extrapulmonary presentation in an immunocompetent host. It is usually the result of direct hematogenous spread from the primary focus. Our patient presented with pain and swelling of the right knee for 6 months. The blood ... ...

Abstract	TB arthritis is a very rare extrapulmonary presentation in an immunocompetent host. It is usually the result of direct hematogenous spread from the primary focus. Our patient presented with pain and swelling of the right knee for 6 months. The blood investigations and CT chest revealed findings consistent with active tuberculosis. Synovial fluid was positive for acid-fast bacilli (AFB) which is a very rare finding. Cartridge-based nucleic acid amplification test (CBNAAT) revealed Mycobacterium tuberculosis and sensitivity to rifampicin. Establishing the diagnosis of Mycobacterium tuberculosis beyond doubt is very important, and early initiation of antitubercular treatment (ATT) is important as delay in treatment may lead to irreversible damage to the joint and restriction of joint mobility.
MeSH term(s)	Humans ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy ; Mycobacterium tuberculosis/genetics ; Rifampin/therapeutic use ; Antitubercular Agents/therapeutic use ; Nucleic Acid Amplification Techniques
Chemical Substances	Rifampin (VJT6J7R4TR) ; Antitubercular Agents
Language	English
Publishing date	2023-04-18
Publishing country	India
Document type	Case Reports
ZDB-ID	197621-7
ISSN	0974-5130 ; 0377-4929
ISSN (online)	0974-5130
ISSN	0377-4929
DOI	10.4103/ijpm.ijpm_341_21
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Article ; Online: Gout in African Americans.

Krishnan, Eswar

The American journal of medicine

2014 Volume 127, Issue 9, Page(s) 858–864

Abstract: Purpose: African Americans have a substantially higher prevalence of risk factors for gout than Caucasians. The aim of the present study was to compare the risk for incident gout among African Americans and Caucasians.: Methods: Incidence rates of ... ...

Abstract	Purpose: African Americans have a substantially higher prevalence of risk factors for gout than Caucasians. The aim of the present study was to compare the risk for incident gout among African Americans and Caucasians. Methods: Incidence rates of physician-diagnosed gout among 11,559 Caucasian men and 931 African American men aged 35 to 57 years and at high cardiovascular risk, observed for 7 years as a part of the Multiple Risk Factor Intervention Trial, were analyzed. Cox regression models were used to account for potential confounding by age, body mass index, diuretic use, hypertension and diabetes status, aspirin and alcohol consumption, and kidney disease. Results: At baseline, after accounting for risk factors, African Americans had a 14% lower prevalence of hyperuricemia than Caucasians. Incidence of gout increased with increasing prevalence of risk factors in both Caucasians and African Americans. Ethnic disparities in incidence rates were most apparent among those without other risk factors for gout. In separate Cox regression models, after accounting for risk factors, African American ethnicity was associated with a hazard ratio of 0.78 (95% confidence interval [CI], 0.66-0.93) for physician-diagnosed gout and 0.88 (95% CI, 0.85-0.90) for incident hyperuricemia. Significant interactions were observed; the association was the strongest (hazard ratio 0.47; 0.37-0.60). These associations were unaffected by addition of serum urate as a covariate or by using alternate case definitions for gout. Conclusions: After accounting for the higher prevalence of risk factors, African American ethnicity is associated with a significantly lower risk for gout and hyperuricemia compared with Caucasian ethnicity.
MeSH term(s)	Adult ; African Americans ; European Continental Ancestry Group ; Follow-Up Studies ; Gout/diagnosis ; Gout/ethnology ; Gout/etiology ; Health Status Disparities ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Proportional Hazards Models ; Risk Factors ; United States/epidemiology
Language	English
Publishing date	2014-09
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2014.03.039
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Article ; Online: Interaction of inflammation, hyperuricemia, and the prevalence of hypertension among adults free of metabolic syndrome: NHANES 2009-2010.

Krishnan, Eswar

Journal of the American Heart Association

2014 Volume 3, Issue 2, Page(s) e000157

Abstract: Background: Hyperuricemia and markers of inflammation are correlated with the risk for hypertension. Whether hyperuricemia has any impact on the association between C-reactive protein (CRP) and hypertension is not known.: Methods and results: We ... ...

Abstract	Background: Hyperuricemia and markers of inflammation are correlated with the risk for hypertension. Whether hyperuricemia has any impact on the association between C-reactive protein (CRP) and hypertension is not known. Methods and results: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey, 2009-2010, using ordinary least squares and logistic regression models. Those who met the criteria for metabolic syndrome, had self-reported gout, or were <20 years old were excluded. For each 1-SD increase in serum urate, the serum CRP concentration was 20% higher in unadjusted linear regression models and 13% higher in multivariable linear regression models, after accounting for the effects of age, sex, race, socioeconomic and educational strata, renal function, lipids, smoking, and body mass index. In multivariable models adjusting for the same covariates, hyperuricemia was associated with hypertension with an odds ratio of 2.21 (1.71 to 2.85). When analyzed separately, this was observed in men and women. In multivariable analyses of the overall sample, elevated CRP levels were not associated with hypertension. Conclusions: Among adults free of metabolic syndrome, elevated uric acid, but not elevated CRP, is independently associated with prevalent hypertension.
MeSH term(s)	Adult ; Biomarkers/blood ; C-Reactive Protein/analysis ; Cross-Sectional Studies ; Female ; Humans ; Hypertension/diagnosis ; Hypertension/epidemiology ; Hyperuricemia/blood ; Hyperuricemia/diagnosis ; Hyperuricemia/epidemiology ; Inflammation/blood ; Inflammation/diagnosis ; Inflammation/epidemiology ; Least-Squares Analysis ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Nutrition Surveys ; Odds Ratio ; Prevalence ; Risk Factors ; Time Factors ; United States/epidemiology ; Uric Acid/blood
Chemical Substances	Biomarkers ; Uric Acid (268B43MJ25) ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2014-03-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.113.000157
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Article ; Online: Reply: To PMID 23982888.

Krishnan, Eswar

Arthritis & rheumatology (Hoboken, N.J.)

2014 Volume 66, Issue 6, Page(s) 1686

MeSH term(s)	Gout/epidemiology ; Humans ; Hyperuricemia/epidemiology ; Male ; Renal Insufficiency, Chronic/epidemiology
Language	English
Publishing date	2014-06
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	2756371-6
ISSN	2326-5205 ; 2326-5191
ISSN (online)	2326-5205
ISSN	2326-5191
DOI	10.1002/art.38386
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Article ; Online: Chronic kidney disease and the risk of incident gout among middle-aged men: a seven-year prospective observational study.

Krishnan, Eswar

Arthritis and rheumatism

2013 Volume 65, Issue 12, Page(s) 3271–3278

Abstract: Objective: The kidney is the major organ that facilitates excretion of urate in humans. Surprisingly, few studies have assessed whether a reduced glomerular filtration rate (GFR) and/or kidney damage is associated with a higher incidence of gout, and ... ...

Abstract	Objective: The kidney is the major organ that facilitates excretion of urate in humans. Surprisingly, few studies have assessed whether a reduced glomerular filtration rate (GFR) and/or kidney damage is associated with a higher incidence of gout, and this study was undertaken to address this question. Methods: Data from a 7-year followup of patients enrolled in the Multiple Risk Factor Intervention Trial, a primary prevention trial for cardiovascular disease among 12,866 men ages 35-57 years, were used for the present investigation. Presence of gout was determined by the study physicians from the original trial. Chronic kidney disease was defined using criteria similar to those proposed by the National Kidney Foundation. The Cox proportional hazards regression model was used to assess the association between gout and chronic kidney disease, after accounting for the effects of potential confounders. Results: Overall, there were 722 cases of physician- diagnosed incident gout over 76,602 person-years of followup. The standardized incidence ratio of gout among those with chronic kidney disease was 1,217 (95% confidence interval [95% CI] 1,191-1,244). The adjusted hazard ratio (HR) among those with chronic kidney disease was 1.61 (95% CI 1.60-1.61). Each standard deviation decline in the estimated GFR was associated with an HR of 1.43 (95% CI 1.35-1.51). Including the serum urate level, as well as the urate-chronic kidney disease interaction term, as variables in the second analysis did not attenuate the HR. Proteinuria and hematuria, two markers of kidney damage, were associated with an elevated risk of gout independent of the estimated GFR. Conclusion: Chronic kidney disease manifesting as reduced glomerular function or as presence of blood or protein in the urine increases the risk of incident gout.
MeSH term(s)	Adult ; Disease Progression ; Follow-Up Studies ; Gout/epidemiology ; Humans ; Hyperuricemia/epidemiology ; Incidence ; Male ; Middle Aged ; Prevalence ; Prognosis ; Prospective Studies ; Renal Insufficiency, Chronic/epidemiology ; Risk ; Surveys and Questionnaires
Language	English
Publishing date	2013-12
Publishing country	United States
Document type	Journal Article ; Observational Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	127294-9
ISSN	1529-0131 ; 0004-3591 ; 2326-5191
ISSN (online)	1529-0131
ISSN	0004-3591 ; 2326-5191
DOI	10.1002/art.38171
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Article ; Online: Gout and the risk for incident heart failure and systolic dysfunction.

Krishnan, Eswar

BMJ open

2012 Volume 2, Issue 1, Page(s) e000282

Abstract: Objective: To test the hypothesis that gouty arthritis (gout) is a risk factor for incidence of heart failure and for echocardiographic measures signifying subclinical heart failure.: Design: Post-hoc, longitudinal and cross-sectional analyses of a ... ...

Abstract	Objective: To test the hypothesis that gouty arthritis (gout) is a risk factor for incidence of heart failure and for echocardiographic measures signifying subclinical heart failure. Design: Post-hoc, longitudinal and cross-sectional analyses of a prospective cohort study where data were collected in 4-year intervals since 1971. Settings: The population-based Framingham Offspring Study. Participants: 4989 adults (mean age 36 years, 52% women) free of clinical heart failure at baseline. Outcome measures: Incident heart failure, echocardiographic measures of left ventricular systolic dysfunction, dilatation and hypertrophy. Results: Participants with gout (n=228) had two to three times higher incidence of clinical heart failure and echocardiographic measures of systolic dysfunction compared with those without. In Cox regression analyses, gout was associated with an adjusted HR of 1.74 (95% CI 1.03 to 2.93) for incident heart failure and RRs of 3.70 (95% CI 1.68 to 8.16) for abnormally low left ventricular ejection fraction and of 3.60 (95% CI 1.80 to 7.72) for global left ventricle systolic dysfunction. These risk relationships were consistently observed in all clinical subgroups. Overall, participants with gout had greater mortality than those without (adjusted HR 1.58, 95% CI 1.40 to 1.78). Mortality was elevated in subgroup of patients with gout and heart failure (adjusted HR 1.50, 95% CI 1.30 to 1.73) compared to those with heart failure but without gout. Conclusion: Gout is associated with increased risk for clinical heart failure, subclinical measures of systolic dysfunction and mortality.
Language	English
Publishing date	2012-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2011-000282
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Article ; Online: Reduced glomerular function and prevalence of gout: NHANES 2009-10.

Krishnan, Eswar

PloS one

2012 Volume 7, Issue 11, Page(s) e50046

Abstract: Background: The renal tubule is a major route of clearance of uric acid, a product of purine metabolism. The links between reduced glomerular filtration rate (GFR), hyperuricemia, and gout in the general population are not well understood. The objective ...

Abstract	Background: The renal tubule is a major route of clearance of uric acid, a product of purine metabolism. The links between reduced glomerular filtration rate (GFR), hyperuricemia, and gout in the general population are not well understood. The objective of the present study was to estimate prevalence of gout and hyperuricemia among people with impaired GFR in the US general population. Study design: Cross-sectional, survey-weighted analyses of data on adults (age>20 years) in the 2009-10 cycle of the US National Health and Nutrition Examination Surveys (n = 5,589). Associations between self-reported physician diagnosis of gout and degrees of renal impairment were the primary focus of the present analyses. Results: In the 2009-2010 period, there was an estimated 7.5 million people with gout in the US. There were 1.25 million men and 0.78 million women with moderate or severe renal impairment and gout. The age standardized prevalence of gout was 2.9% among those with normal GFR compared to 24% among those with GFR<60 ml/min/1.73 m(2).In multivariable logistic regression analyses that adjusted for age, gender, body mass index, hypertension, diabetes, hypertension medications, including diuretics, blood lead levels, and hyperlipidemia, the odds ratios of gout and hyperuricemia were 5.9 (2.2, 15.7) and 9.58 (4.3, 22.0) respectively among those with severe renal impairment compared to those with no renal impairment. Approximately 2-3 fold increase in prevalence of gout was observed for each 30 ml/min/1.73 m(2) decrease in GFR, after accounting for the above factors. Conclusions: Renal glomerular function is an important risk factor for gout. The prevalence of hyperuricemia and gout increases with decreasing glomerular function independent of other factors. This association is non-linear and an eGFR of 60 ml/min/1.73 m(2) appears to be a threshold for the dramatic increase in the prevalence of gout.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Glomerular Filtration Rate ; Gout/epidemiology ; Humans ; Hyperuricemia/blood ; Hyperuricemia/epidemiology ; Kidney Glomerulus/physiopathology ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Uric Acid/blood ; Young Adult
Chemical Substances	Uric Acid (268B43MJ25)
Language	English
Publishing date	2012-11-27
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0050046
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Article ; Online: Inflammation, oxidative stress and lipids: the risk triad for atherosclerosis in gout.

Krishnan, Eswar

Rheumatology (Oxford, England)

2010 Volume 49, Issue 7, Page(s) 1229–1238

Abstract: For many years, the relationship between cardiovascular disease risk and gout, though strong and consistent, was suspected of being coincidental rather than causative. In recent years, compelling epidemiological and clinical data have increasingly ... ...

Abstract	For many years, the relationship between cardiovascular disease risk and gout, though strong and consistent, was suspected of being coincidental rather than causative. In recent years, compelling epidemiological and clinical data have increasingly favoured an aetiological connection. However, that connection is notably complex, involving a multifaceted model that includes interactions between inflammatory processes, oxidative stress and potential genetic influences, as well as cardiovascular and renal components that remain only partly explained. Urate appears to be able to activate the immune response, and in that context has a mediating role in the inflammatory process via the inflammasome. This interaction of urate and inflammation is central to the inflammatory cascade associated with gout flares. In the arena of oxidative stress, urate has both antioxidant and pro-oxidant properties, and while potentially beneficial in scavenging free radicals, it can also impair endothelial function and thereby give rise to atherosclerotic risk. Human and animal studies have revealed associations between hyperuricaemia and a host of atherosclerotic risk factors, whereas a reduction in urate levels is frequently associated with improvement or even resolution of such risk factors. The degree to which reduction of serum urate can reliably improve cardiovascular risk remains uncertain. It is hoped that the introduction of newer urate-lowering agents may help to clarify this picture and improve treatment options for both gout and atherosclerosis.
MeSH term(s)	Atherosclerosis/etiology ; Gout/complications ; Humans ; Hyperuricemia/complications ; Inflammasomes/blood ; Inflammasomes/metabolism ; Lipid Metabolism ; Lipids/blood ; Lipids/physiology ; Oxidative Stress/physiology ; Risk ; Uric Acid/blood ; Uric Acid/metabolism
Chemical Substances	Inflammasomes ; Lipids ; Uric Acid (268B43MJ25)
Language	English
Publishing date	2010-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/keq037
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Article: Training overseas doctors in the United Kingdom. Consider moving to the US.

Krishnan, E

BMJ (Clinical research ed.)

2001 Volume 322, Issue 7278, Page(s) 109–110

MeSH term(s)	Education, Medical, Graduate/organization & administration ; Emigration and Immigration ; Humans ; United Kingdom ; United States
Language	English
Publishing date	2001-01-13
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8138 ; 0959-8154 ; 0959-8146 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8138 ; 0959-8154 ; 0959-8146 ; 0959-535X ; 1759-2151
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Article ; Online: Hyperuricemia and incident heart failure.

Krishnan, Eswar

Circulation. Heart failure

2009 Volume 2, Issue 6, Page(s) 556–562

Abstract: Background: Hyperuricemia, a known correlate of oxidative stress, is a marker for adverse prognosis among individuals with heart failure. However, the relationship between hyperuricemia and the risk for incidence of heart failure in a community-based ... ...

Abstract	Background: Hyperuricemia, a known correlate of oxidative stress, is a marker for adverse prognosis among individuals with heart failure. However, the relationship between hyperuricemia and the risk for incidence of heart failure in a community-based population has not been studied. Methods and results: We prospectively analyzed the relationship between serum uric acid concentration at baseline and subsequent heart failure among the participants of the Framingham Offspring cohort (n=4912; mean baseline age, 36 years; 52% women). By using Cox regressions, we calculated the risk of heart failure with increasing serum uric acid after adjusting for sex, age, smoking, body mass index, renal dysfunction, diuretics, systolic blood pressure, valvular heart disease, diabetes, alcohol, and use of antihypertensive medications. The incidence rates of heart failure were approximately 6-fold higher among those at the highest quartile of serum uric acid (>6.3 mg/dL) compared with those at the lowest quartile (<3.4 mg/dL). The adjusted hazard ratio for the highest quartile of serum uric acid compared with the lowest was 2.1 (1.04 to 4.22). The relationship between hyperuricemia and heart failure was found in participants without metabolic syndrome and other subgroups as well. Conclusions: Hyperuricemia is a novel, independent risk factor for heart failure in a group of young general community dwellers. This has implications for development of preventive strategies for heart failure.
MeSH term(s)	Adult ; Biomarkers/blood ; Female ; Heart Failure/blood ; Heart Failure/epidemiology ; Heart Failure/etiology ; Humans ; Hyperuricemia/blood ; Hyperuricemia/complications ; Hyperuricemia/epidemiology ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Uric Acid/blood ; Young Adult
Chemical Substances	Biomarkers ; Uric Acid (268B43MJ25)
Language	English
Publishing date	2009-08-06
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2429459-7
ISSN	1941-3297 ; 1941-3289
ISSN (online)	1941-3297
ISSN	1941-3289
DOI	10.1161/CIRCHEARTFAILURE.108.797662
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