Introduction Austrian syndrome, defined by the triad of pneumococcal pneumonia, meningitis, and infective endocarditis (IE), represents a rare but severe form of invasive pneumococcal disease (IPD). Despite advances in vaccination and antimicrobial therapy, it remains associated with high morbidity and mortality due to diagnostic delays. We report a diagnostically challenging case of Austrian syndrome in an immunocompetent elderly male, complicated by multifocal septic arthritis and delayed recognition of IE. Case description A 71-year-old man with no history of pneumococcal vaccination, smoking, or alcohol use initially presented with acute monoarthritis of the right knee. Both blood and synovial cultures yielded Streptococcus pneumoniae serotype 19A with reduced susceptibility to penicillin. During hospitalization, he developed acute confusion and right wrist arthritis. Chest imaging revealed right lower lobe consolidation, and brain magnetic resonance imaging demonstrated leptomeningeal enhancement consistent with meningitis. Transthoracic echocardiography was initially negative. However, subsequent transoesophageal echocardiography revealed aortic valve vegetations with annular abscess, confirming definite IE according to modified Duke criteria. The combination of pneumonia, meningitis, and IE established the diagnosis of Austrian syndrome. The patient was managed with prolonged targeted intravenous antibiotics, achieving full clinical and microbiological recovery without surgical intervention. Conclusion This case illustrates the diagnostic complexity of Austrian syndrome in an immunocompetent elderly patient lacking classical risk factors or respiratory symptoms. It underscores the pivotal role of transoesophageal echocardiography in IE diagnosis, highlights the therapeutic potential of prolonged targeted antimicrobial therapy, and reinforces the importance of pneumococcal vaccination to prevent severe IPD.

Supercharged end-to-side anterior interosseous nerve transfer to restore the intrinsic motor function in osteoarthritis-induced cubital tunnel syndrome.

The Outerbridge-Kashiwagi (O-K) procedure has been widely used to treat elbow osteoarthritis by improving range of motion and alleviating mechanical impingement. Supercharged end-to-side (SETS) anterior interosseous nerve (AIN) transfer has emerged as a promising technique for restoring hand muscle function in patients with ulnar nerve palsy. However, no previous studies have evaluated the combined use of these procedures in patients with both elbow arthritis and severe ulnar neuropathy presenting with intrinsic hand muscle atrophy. We hypothesized that the combination of the O-K procedure and SETS AIN transfer would improve both elbow mobility and hand motor strength. A retrospective analysis was performed on 22 patients treated between 2019 and 2023 who underwent a miniopen O-K procedure, cubital tunnel release with anterior transposition, and SETS AIN-to-ulnar motor branch transfer. Inclusion criteria included McGowan grade 3 cubital tunnel syndrome, limited elbow range of motion (ROM) below functional thresholds, and ulnar-innervated intrinsic muscle weakness (MRC grade 0-3) with axonal loss on electromyography. Functional outcomes were evaluated using elbow ROM, MRC grading of the first dorsal interosseous (FDI), grip and pinch strength, index and little finger abduction/adduction strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. At final follow-up, significant improvements were observed in elbow ROM (from 80.9° to 106.5°, P < 0.001), FDI-MRC grade (2.32-3.23, P < 0.001), grip and pinch strength, and DASH scores (P < 0.001). Notably, greater improvement in DASH scores was seen in cases involving the dominant hand. Radiographic assessment revealed sustained fenestration, and no surgical complications were reported. This combined approach addresses both mechanical impingement and motor deficits, offering a feasible and effective strategy for restoring upper extremity function in this patient population. Preoperative electrophysiologic assessment plays a key role in optimizing candidate selection and outcomes.

LncRNA transcriptomics elucidates the suppression of gouty arthritis-associated pyroptosis by Pulchinenoside B4 through NLRP3 inflammasome modulation.

Phillyrin: A review of its pharmacokinetics and multi-target anti-inflammatory mechanisms for therapeutic potential.

Phaseoloidin, a homogentisic acid glucoside from Entada phaseoloides, suppresses gout inflammation via NLRP3 inflammasome.

Diagnostic Pitfalls and Conservative Management of Acute Culture-Negative Arthritis Following Total Knee Arthroplasty

Potential components and action mechanism of Tongzhi Surunjiang Pills against acute gouty arthritis: UPLC-MS/MS, network pharmacology, molecular docking, and transcriptomic analysis.

Huazhuo Sanjie Chubi Decoction attenuates gouty arthritis and kidney fibrosis by regulating urate transporters and JAK2/STAT3 pathway.

This study aims to investigate the diagnostic value of 18F-NaF micro PET/CT imaging in mouse models of acute gouty arthritis (AGA). Three male Balb/c mice were designated as the normal control group (Group A), and 18 male Balb/c mice were used to establish the AGA model (Group B). Group A and model groups B (B 1h, B 3h, B 6h, B 8h, B 12h, B 24h) underwent micro PET/CT imaging 40 minutes after injection of the radiotracer. All groups of mice underwent complete blood count, blood uric acid testing, and pathological biopsy of the ankle joint. The results showed that the counts of inflammatory cells in the blood routine of Group B were higher than those of Group A, and there were statistically significant differences between Group B 6h and B 8h compared to Group A ( P < 0.05). 18F-NaF micro PET/CT imaging revealed abnormal tracer accumulation in the right ankle joints of group B, but no bone destruction were observed on CT at the lesion sites; In group A, there was no obvious abnormal gathering of tracer in the left ankle joint. The ratios of maximum standardized uptake value (SUVmax) of the right and left ankle joints (R/L SUVmax) in Group B were higher than those in Group A, and the difference between Group B 6h and Group A was statistically significant ( P < 0.05). The R/L SUVmax ratios were positively correlated with the counts of white blood cells and neutrophils in the blood routine and microscopic inflammatory cells ( R = 0.79, P < 0.01; R = 0.72, P < 0.01; R = 0.79, P < 0.01, respectively). Overall, 18F-NaF micro PET/CT imaging can detect early bone metabolism changes in AGA and visually monitor its dynamic pathophysiological progression.

Septic arthritis (SA) is a rare but serious disease. There is no reliable marker for rapid diagnosis. Synofast® is a new device that analyses synovial fluid and can accurately rule out SA within 15minutes. To evaluate the diagnostic performance of Synofast® in routine practice in patients with suspected SA and to assess its impact on patient care. This was a monocentric prospective study of patients with acute arthritis of possible septic origin. In addition to the usual blood and synovial bacteriological tests, a drop of synovial fluid was taken for the Synofast® test, which provides three SA risk probabilities: "low", "possible" or "high". The physician recorded the management he would have given before the test and the management he actually gave after the test, knowing the diagnostic performance reported in previous studies. Over one year, 43 patients were included, of whom eight had SA (18.6%). Sensitivity, negative predictive value (PV) and negative likelihood ratio (LR) were respectively of 75%, 93% and 0.32 when analysing for "high" and "possible" septic risk while specificity, positive PV and positive LR were respectively of 94%, 67% and 8.75 when analysing for "high" septic risk only. The test helps to avoid hospitalisations in 1/29 patients and to defer antibiotic in 1/7 patients. Follow-up and drug management remained unchanged in 95% and 89% of patients, respectively. Synofast® seems to be a valuable tool for the exclusion of SA. The results need to be confirmed in a larger population, especially the impact on management.

Clinical guidelines are a key tool in practical medicine; their primary purpose is to improve the effectiveness of treatment for somatic diseases. The guidelines systematize research data concerning various therapeutic options and regimens, as well as the efficacy and safety of medicinal products, which potentially reduces the risk of complications and improves disease outcomes when accumulated experience is applied rationally. In 2025, the clinical guidelines for idiopathic gout were updated. This article discusses the main approaches to prescribing symptomatic therapy aimed both at alleviating acute arthritis attacks and at preventing subsequent gout flares during the initiation of urate-lowering therapy.

Research on spontaneous resolution of acute gout remains limited. Macrophages pyroptosis is crucial for the inflammation of acute gout, while current research mainly focus on Caspase 1/Gasdermin D axis. We aimed to investigate the involvement of other Gasdermin proteins in MSU crystal-induced macrophages, and to explore the role of Caspase 3-interacting protein alpha-1 antitrypsin (AAT) in regulating macrophage pyroptosis. Here, clinical evidence demonstrated elevated Gasdermin E (GSDME) in peripheral blood mononuclear cells (PBMCs) and CD68+ synovial macrophages from patients with acute gout. In THP-1-derived macrophages, activated Caspase 3/GSDME axis was found after MSU crystals stimulation, and knockdown of Caspase 3 and GSDME significantly suppressed pyroptosis. In vivo, the Caspase 3 inhibitor effectively alleviated MSU crystal-induced acute gouty arthritis in mice. Cytologically, Caspase 3 interacting protein AAT was identified using immunoprecipitation and mass spectrometry technology. Meanwhile, AAT was elevated in serum, PBMCs, synovial fluids, and CD68+ synovial macrophages from patients with acute gout. Furthermore, AAT inhibited Caspase 3/GSDME-dependent pyroptosis axis by binding to Caspase 3 in MSU crystal-induced macrophages. Additionally, AAT was internalized into macrophages via low-density lipoprotein receptor-related protein-1. Collectively, elevated AAT in synovial fluids from patients with acute gout attenuates macrophage pyroptosis by inhibiting Caspase 3/GSDME axis, providing a novel explanation for the spontaneous resolution of acute gout.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10753-025-02424-z.

Acute gouty arthritis (AGA) is a common inflammatory joint disease with limited therapeutic options and notable side effects from conventional treatments. This study investigated the anti-inflammatory effects and underlying mechanisms of the traditional Chinese herbal formula Wu Miao Pill (WMP) in a rat model of AGA induced by monosodium urate crystals. WMP administration markedly alleviated joint inflammation and swelling, improved synovial histopathology, and reduced the expression of P2X7 receptor (P2X7R) and pro-inflammatory cytokines IL-1β, IL-18, and TNF-α. P2X7R inhibition and knockdown experiments confirmed its central role in the therapeutic effect of WMP. Network pharmacology further revealed multiple active compounds targeting inflammatory pathways, notably IL-17 and NF-κB signaling. Overall, WMP exhibits significant anti-inflammatory efficacy through modulation of P2X7R and related pathways, providing experimental and mechanistic evidence for its potential as a novel therapeutic agent for AGA.

Asymptomatic hyperuricemia (AHU) and gout are pathological conditions characterized by elevated uric acid (UA) levels in the blood. Gout is characterized by acute arthritis attacks due to UA crystallization in the joints. Other differences between AHU and gout require further study. Study objective . To identify key differences between AHU phenotypes. Materials and methods . 220 patients with HU (UA &gt;360 μmol/L) over 18 years of age were examined and divided into the following phenotypes: AHU; AHU with monosodium urate crystals (verified by ultrasound or synovial fluid analysis) (AHU+crystals); intermittent gout (G); tophaceous gout (G+tophi). Comparative characteristics of the groups included an assessment of the frequency of comorbidities, metabolic disorders, and the main laboratory parameters. Results . According to phenotyping results, the group of patients with AHU included 40 people (18.2%), AHU+crystals – 26 (11.8%), G – 111 (50.5%), G+tophi – 43 (19.5). The average age in the groups was comparable (p=0.5). An increase in the frequency of hypertension and nephrolithiasis was revealed in the series AHU without crystals – AHU+crystals – G – G+tophi (p=0.0006 and p=0.00006, respectively). Similar patterns were found for the mean serum levels of UA (p=0.00001), creatinine (p=0.0003), and GGT (p=0.0003), the mean values of which increased sequentially from AHU to G+tophi. The maximum mean levels of CRP were in patients with G and G+tophi (5.3 [2.3; 12.5] mg/L), which was significantly higher than in AHU patients (p=0.04). GFR was lower in the G+tophi group compared to AHU (74.7±20.0 ml/min/1.73m 2 vs 86.8±17.9 ml/min/1.73m 2 , respectively, p=0.02). Conclusions . The incidence of hypertension, nephrolithiasis, serum GGT and creatinine levels increases as HU progresses from AGU to G+tophi, which may reflect the intensity of chronic microcrystalline inflammation.

Development of P(NVCL)-based transdermal patches for sinomenine hydrochloride delivery in gouty arthritis.

IL-6: A new target in crystal-induced arthritides-A narrative review.

Resveratrol-loaded DNA tetrahedron nanocarrier attenuates acute gouty arthritis via dual modulation of apoptosis and pyroptosis pathways

Calcium pyrophosphate deposition (CPPD) disease is a common, age-related crystalline arthropathy with diverse clinical presentations. While the knees and wrists are most frequently affected, shoulder involvement is increasingly recognized, occurring in up to 13% of cases, though often underdiagnosed. This mini-review provides a comprehensive overview of the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of shoulder CPPD, contextualized by an illustrative case of a 78-year-old woman with atypical calcifications in the axillary recess and supraspinatus muscle. A key focus is the diagnostic challenge when synovial fluid analysis, the gold standard for crystal confirmation, is technically unfeasible, a common scenario in clinical practice. We systematically discuss modern imaging techniques (ultrasound, dual-energy computed tomography [CT], conventional radiography) and demonstrate the practical application of the 2023 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for establishing probable CPPD when crystal analysis is unavailable. The review addresses critical differential diagnosis considerations, particularly distinguishing CPPD from basic calcium phosphate (BCP) deposition disease, and summarizes evidence-based therapeutic strategies for acute pseudogout flares and chronic inflammatory arthritis, including emerging biologic therapies targeting the interleukin-1 (IL-1) pathway. This comprehensive resource aids clinicians managing shoulder calcifications in the absence of definitive crystal confirmation.

Non-neoplastic Orthopedic Pathology Updates: Common Problems and Pitfalls and How to Avoid Them.