Arthritis Mutilans Due To Chronic Tophaceous Gout

Content

• Stage 3: Interval Or Intercritical Gout
• Case History
• A Rare Case Of Ulcerated Tophaceous Gout
• Data Abstraction And Data Management
• Acute Gout Flare

Although symmetric joint involvement can be seen in chronic tophaceous gout, it is often mistaken for RA. A 39-year-old man with an ulcerated tophi on the back of his left foot was referred to the Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, in December 2007. He had been suffering from chronic tophaceous gout for more than 12 years in multiple joints of his hands and feet with recurrent acute arthritis attacks several times a year. Two months before admission, the patient felt severe pain with local redness and increased skin temperature on the back of his left foot. He found the soft tissue breakdown overlying tophi and ulceration on the back of his left foot. He was admitted to a local hospital and took some drugs such as allopurinol and benzbromarone tablets, conservative debridement, and got dressings changed.

The highest incidence is seen at the end of the third and beginning of the fourth decades of life, with predominance in the male sex (95% of the cases). There is some overlap, with 40 percent of gout sufferers also suffering from CPPD. Rheumatoid arthritis can present clinically similar, but this is a symmetrical polyarticular disease producing fusiform soft tissue swelling, without sclerosis along the margins of the erosions that occur. Septic arthritis can also present in a similar fashion to gout, but easy differentiation can be made at the time of aspirate analysis, by the recognition of needle-shaped crystals with negative birefringence in gout. Psoriatic arthritis can also present similarly, but may be differentiated by the more extensive involvement of the sacroiliac joints and paravertebral ossification.

Stage 3: Interval Or Intercritical Gout

Before menopause women have a significantly lower risk for gout than men, possibly because of the actions of estrogen. After menopause the risk increases in women so that after age 60 the incidence is equal in men and women, and after 80, gout occurs more often in women. Chills and mild fever, loss of appetite, and feelings of ill health may occur with an attack. Asymptomatic hyperuricemia, in which MSU slowly builds up, always precedes gout and is considered the first stage of the disorder. We had a relatively low complication rate at 3% as compared with other studies . The only one post-operative complication was a wound infection at the big toe which was related to early mobilization.

Gout is a painful form of arthritis that occurs when too much uric acid builds up in the body. Uric acid is a normal waste product in the blood that comes from the breakdown of certain foods. Uric acid crystals can form kidney stones, a complication that occurs in about 15 percent of people with gout. In gout’s earliest stages, uric acid accumulates in the blood, causing a condition known as hyperuricemia. There are usually no symptoms, and no treatment is required—but the uric acid could still be harming your body.

Case History

One highly visible manifestation is gout tophi, or large bumps that form where gout crystals have accumulated. Treatment options for acute gouty attacks include dietary and lifestyle modifications, NSAIDs, colchicine, oral or topical steroids and corticotropin . Even without treatment acute attacks usually resolve spontaneously within seven to 10 days. Normalizing hyperuricemia is of cardinal significance for the control of recurrent attacks and for the regression of tophi. This is achieved with drugs, which either favor uric acid excretion , convert uric acid into soluble allantoin , or inhibit uric acid production . Laboratory workup revealed leukocytosis (14.524/mm3), elevated C-reactive protein (7.21 mg/dl) and elevated serum uric acid (14 mg/dl).

How do you dissolve gout tophi?

Several drugs have been found effective at lowering levels of uric acid in the blood to 5 milligrams/deciliters (mg/dL), which is the point at which tophi will dissolve. These include Aloprim (allopurinol), Uloric (febuxostat), Krystexxa (pegloticase), and Benemid (probenecid).

Key informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. The results of the report are intended for primary care and acute care settings; however it is understood that the studies of interest might be conducted in academic and other specialty medical settings. Radiographs of the thoracic spine demonstrated absent pedicles at the T5, T6, and T7 levels .

Chronic inflammation and tophi can lead to permanent joint damage, deformity, and stiffness. In the worst cases of chronic gout, you may need surgery to fix joint damage, or replace joints. Febuxostat (trade name Adenuric®) is a new medication for gout that may be used to reduce urate levels in patients with poor kidney function or intolerant of allopurinol. Phase III clinical trials have reported febuxostat to be more effective than allopurinol at a dose of 300mg.

Correction and prevention of hyperuricemia - Uricosuric drugs or allopurinol may be used alone or in conjunction. Hypouricemic therapy may also be used for patients with tophi and a higher recurrance rate. Dietary restriction of high-purine foods is a less effective treatment technique but is still recommended.

Poor hygiene was noted at the foot dressing together with early excessive mobilization. Wound debridement was subsequently performed and healed with no further complication. No routine perioperative colchicine was given for prophylactic purpose. The anaesthesia employed included regional, spinal and general anaesthesia. We used a tourniquet for all patients to create a bloodless surgical field for both upper and lower limbs.

What Are Gout Tophi?

Hypoxanthine is metabolized to xanthine, which is metabolized to uric acid. These two last steps are catalyzed by the enzyme xanthine oxidase, which is the major site for pharmacologic intervention by allopurinol. In humans, uric acid is the final product; humans lack the ability to degrade urate further. X-rays in gout differ from those in rheumatoid arthritis in that there is no periarticular osteopenia. Erosions are seen in gout, but without surrounding decreased bone density.

How can I check my uric acid levels at home?

A uric acid test measures the amount of uric acid in the body. Uric acid is a chemical that's produced when your body breaks down purines.
How is a uric acid urine test performed? 1. On day 1, urinate into the toilet after waking up.
2. After that, take note of the time and collect all urine for the remaining 24 hours.

3 The prevalence of gout is much higher in men than in women and rises with age. Although the prevalence of tophaceous gout, principally the generalized form of it, has decreased in the past years, the disease still exists likely due to the absence of an accurate diagnosis and therapy. Gout is a common type of inflammatory arthritis that affects about 2 out of every 100 people in the United States. Arthritis refers to more than 100 different conditions that cause joint pain or disease. The search strategy was designed by our reference librarian in collaboration with our local content expert, who has participated in two systematic reviews on gout; the search strategy appears in an appendix at the end of this protocol. As recommended by the Methods Guide for Medical Test Reviews,11 the searches will not use filters specific for diagnostic tests but instead will use the terms “gout” combined with the terms for the diagnostic tests.