This case report describes an unusual form of gout, called miliarial gout, in association with carpal tunnel syndrome in a 54-year-old woman. Miliarial gout was first described in 2007 and is a very rare presentation of chronic tophaceous gout. The latter condition can cause carpal tunnel syndrome, but this association has not previously been described in association with miliarial gout. In addition, the authors discuss the use of the parsimony principle in internal medicine whereby a single cause is first sought for different symptoms presenting at the same time.

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Introduction. Cardiovascular mortality in patients diagnosed with seronegative spondyloarthritis (SSN) is on the rise. Impairment of the cardiovascular system in ankylosing spondylitis (SpA) is 20-40%, in psoriatic arthritis (APs) 18-22% and in reactive arthritis (ARe) 1-3%.Material and methods. The study included 77 patients diagnosed with SSN. Laboratory (erythrocyte sedimentation rate – ESR, C-reactive protein – CRP, fibrinogen) and instrumental (echocardiography – EcoCG, electrocardiogram – ECG) data were analyzed.Results. In 35 patients diagnosed with SpA, the left branch hemiblock of the Hiss bundle was determined – 71% and bradycardia – 57%. Aortic valve (VAo) changes were diagnosed in 54% and left ventricular hypertrophy (LVH) in 57%. Elevated CRP values were found in 34.5% of cases, ESR – 22.8% and fibrinogen – 17.2%. In 24 patients with APs, 33.5% showed VAo induration and fibrosis. Another change diagnosed in these patients was LVH (37.5%). Cardiac conductivity disorders in 25% were due to the left branch hemiblock of the Hiss bundle, and among the increased inflammatory markers were: fibrinogen (16.6%) and CRP (12.5%). In 18 patients with ARe as a rhythm disorder, tachycardia is predominant – 94% and VAo damage in 27.7%. Inflammatory markers with values above the upper limit were fibrinogen (66%) and CRP (33%).Conclusions. Our study showed that SSN is closely related to the inflammatory syn-drome, on which the activity of the disease and the degree of damage to the cardiovascular system depend. Most often the heart is affected with its components.