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Rapid symptom relief occurred after etoricoxib plus benzbromarone, with rationale for selecting benzbromarone based on faster urate-lowering and fewer reported adverse effects in Asian populations. Supplementary diagnosis and treatment records support costochondral gout management.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/new-challenges-in-diagnosis-and-treatment-of-chest-pain-in-the-patient-with-hyperuricemia-clinical-vignette/416693/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/new-challenges-in-diagnosis-and-treatment-of-chest-pain-in-the-patient-with-hyperuricemia-clinical-vignette/416693.png","ImageObject",300,407,{"name":42,"@type":43},"Guten 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benzbromarone selected for long-term management?",{"text":72,"@type":64},"The case report notes rapid pain relief with etoricoxib plus benzbromarone and compares urate-lowering performance, highlighting benzbromarone’s faster absorption efficiency and higher uric acid reduction rate versus allopurinol or febuxostat, with fewer adverse-effect reports in Asian populations.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},416693,1790810877,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & 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diagnosis and treatment of chest pain in the patient with hyperuricemia  \nYubing Zhang1,‡, Dongming Han2,‡, Yuhua He2, Xiaoyao Chang1, Ping Lu3, Tao Zhang4, Yanlong Jia4, Hongqin Zhuang1, 􀀃 , Zichun Hua 1,4,5, 􀀃  \n1State Key Laboratory of Pharmaceutical Biotechnology and Department of Neurology of Nanjing Drum Tower Hospital, School of Life Sciences and Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China  \n2 Department of Magnetic Resonance, First Affiliated Hospital of Xinxiang Medical University, Weihui, China  \n3 Department of Oncology, First Affiliated Hospital of Xinxiang Medical University, Weihui, China 4Faculty of Pharmaceutical Sciences, Xinxiang Medical University, Xinxiang, China  \n5Changzhou High-Tech Research Institute of Nanjing University and Jiangsu Target Pharma Laboratories, Changzhou, China  \n􀀃 Correspondence to: Zichun Hua, State Key Laboratory of Pharmaceutical Biotechnology and Department of Neurology of Nanjing Drum Tower Hospital, School of Life Sciences and Affiliated Hospital of Nanjing University Medical School, Nanjing University, No. 163 Xianlin Avenue, Qixia District, Nanjing City, Jiangsu Province 210023, China. Email: [hzc1117@nju.edu.cn](hzc1117@nju.edu.cn); Hongqin Zhuang, State Key Laboratory of Pharmaceutical Biotechnology and Department of Neurology of Nanjing Drum Tower Hospital, School of Life Sciences and Affiliated Hospital of Nanjing University Medical School, Nanjing University, No. 163  \nXianlin Avenue, Qixia District, Nanjing City, Jiangsu Province 210023, China. Email: [hqzhuang@nju.edu.cn](hqzhuang@nju.edu.cn)  \n‡Y.Z. and D. H. contributed equally.  \nA 27-year-old man presented to our outpatient department with a 3-day history of acute anterior chest pain. He had a history of gout and was first diagnosed with hyperuricemia  \n(serum uric acid level 518 μmol/l) at the age of 24. In the days leading up to this visit, he experienced daily chest pain that progressively worsened from morning to night. The pain was  \nFigure 1 The imaging examination results of the patient: (A) chest photograph,(B) costal cartilaginous musculoskeletal ultrasonography,(C) chest DECT image and (D) DECT examination of both hands and feet  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the British Society for Rheumatology.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.  \n2 Rheumatology Advances in Practice, 2026, Vol, 10, Issue 1  \nsharp and localized over the costal cartilage, especially on palpation.  \nPhysical examination revealed no significant abnormalities in the lungs or heart and no visible redness or swelling was observed over the chest wall (Fig. 1A) . Laboratory tests showed a mildly elevated C-reactive protein level (1.76 mg/l) . Musculoskeletal ultrasound revealed dot-like echogenic focion the costal cartilage (Fig. 1B) . Dual-energy computed tomography (DECT) of the chest wall demonstrated green colorization along the costochondral cartilage, indicating the presence of monosodium urate crystals (Fig. 1C) . However, DECT of the hands and feet showed no crystal deposition (Fig. 1D) .  \nThe patient was treated with etoricoxib (120 mg/day) and benzbromarone (100 mg/day), resulting in rapid pain relief within 2 days. Compared with allopurinol and febuxostat, benzbromarone demonstrates a faster absorption efficiency and a higher rate of uric acid reduction. Furthermore, there are fewer reports of adverse effects related to benzbromaronein Asian populations. Based on the evidence, we chose benzbromarone for treatment of this patient. Further documentation of similar clinical presentations and outcomes may help improve our un","cbCaiuzTd36nRDy8","https://ap.wps.com/l/cbCaiuzTd36nRDy8","pdf",560464,"English","# Clinical vignette\n## Case presentation and symptoms\n## Diagnostic evaluation (ultrasound and DECT)\n## Treatment and outcomes\n## Supplementary and publication information","[{\"question\":\"What prompted further evaluation of the patient’s chest pain?\",\"answer\":\"The patient had a gout history and a recent 3-day course of progressively worsening acute anterior chest pain localized to the costal cartilage, especially on palpation.\"},{\"question\":\"How did imaging support costochondral gout in this case?\",\"answer\":\"Musculoskeletal ultrasound showed dot-like echogenic foci at the costal cartilage, and dual-energy CT demonstrated green colorization along the costochondral cartilage consistent with monosodium urate crystals.\"},{\"question\":\"Why was benzbromarone selected for long-term management?\",\"answer\":\"The case report notes rapid pain relief with etoricoxib plus benzbromarone and compares urate-lowering performance, highlighting benzbromarone’s faster absorption efficiency and higher uric acid reduction rate versus allopurinol or febuxostat, with fewer adverse-effect reports in Asian populations.\"}]","New challenges in diagnosis and treatment of chest pain in the patient with hyperuricemia - Clinical Vignette | PDF",1790606375]