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Gouty Tophus

TOPHUS


Presentation

  • The number of cells present in the corona and fibrovascular zones of the tophus was analyzed by Genmod mixed models analysis. RESULTS: Numerous CD68 mononucleated and multinucleated cells were present within the corona zone.[ncbi.nlm.nih.gov]
  • We present an uncommon presentation of a common disease in a completely asymptomatic woman. She presented with a solitary breast nodule incidentally found on her first mammography.[ncbi.nlm.nih.gov]
  • We present the case of a 72-year-old man with a localization of gouty tophus in the liver, who thereafter developed a hepatocellular carcinoma (HCC) in the same site.[ncbi.nlm.nih.gov]
  • A 64-year-old man with gout presented with history of an enlarging mass in the left upper eyelid causing mechanical ptosis. The patient underwent excisional biopsy. The histopathologic findings confirmed the diagnosis of gouty tophus of the eyelid.[ncbi.nlm.nih.gov]
  • We present a case of an 86-year-old man with a high-grade angiosarcoma that arose within a long-standing tophus.[ncbi.nlm.nih.gov]
Relapsing Polychondritis
  • Polychondritis (2) Sebaceous Cyst (6) Solid-Cystic Basal Cell Carcinoma (85) Synovioma (3) Xanthoma Tuberosum (1) related links Search www.google.com for 'Gouty Tophus' Informationen über Rheuma[dermis.net]
Splenomegaly
  • Gout, an unusual case with softening and subluxation of the first cervical vertebra and splenomegaly: result of ACTH administration and eventual post-mortem findings . Ann Rheumat Dis 1950; 9 : 282–303. 11. Koskoff YD , Morris LE , Lubic LG .[nature.com]
Joint Deformity
  • Complications include bone destruction, joint deformities, and, as in the present case, secondary infections. Diagnosis can be made on clinical grounds and confirmed with the visualization of uric acid crystals under light microscopy.[jaoa.org]
  • Overview Chronic symptoms such as joint deformity and limitation of motion in affected joints may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues.[medlineplus.gov]
Ankle Arthritis
  • KEYWORDS: ankle; arthritis; gout; hyperuricemia; monosodium urate; talar body[ncbi.nlm.nih.gov]
Subcutaneous Nodule
  • In 1996, Iglesias et al. reported a case presented with a 6-year history of multiple subcutaneous nodules and no history of previous articular complaint. [16] They had reviewed literature and found out 28 similar cases that had subcutaneous nodules without[ijcasereportsandimages.com]
  • Here we report a 20-year-old male presenting with multiple subcutaneous nodules on bilateral feet and toes, left palm, right elbow, helix of left ear since last one and half year prior to any other manifestation of gout.[ijdvl.com]
  • Available from: To the Editor, A 68-year-old woman on long-term intermittent hemodialysis (HD) for end-stage renal disease (ESRD) secondary to hypertension presented with three subcutaneous nodules around the metatarsophalangeal joints of both hands ([sjkdt.org]
  • A fifty years old male presented with multiple subcutaneous nodules on both the lateral malleoli and medial border of left great toe ranging in size from 0.5-1.5 cm diameter [Figure 1]. These nodules were firm, mobile and non-tender.[jcytol.org]
Cutaneous Manifestation
  • Clinical cutaneous manifestations of chronic gout are now rarely observed. However, the presence of degenerative tissues, as in idiopathic osteoarthritis of the fingers, may predispose to the deposition of urate crystals.[link.springer.com]
Facial Mass
  • We suggest that US with FNAC should be considered as a tool for evaluating a facial mass before a definite treatment modality is chosen.[journals.lww.com]
Cervical Cord Compression
  • Cervical cord compression due to intradiscal gouty tophus . Spine (Phila Pa 1976) 2012; 37 : E1534–E1536. 10. Kersley GD , Mandel L , Jeffrey MR .[nature.com]
  • Cervical cord compression due to intradiscal gouty tophus: brief report. Spine. 2012;37(24):E1534–6. CrossRef PubMed Google Scholar 19. Lui TH. Acute posterior tarsal tunnel syndrome caused by gouty tophus.[link.springer.com]
Babinski Sign
  • Neurological examination showed decreased left lower limb strength and a positive Babinski sign.[ncbi.nlm.nih.gov]
Clonus
  • Neurological examination showed that his lower limb strength had decreased (Grade 4/5) on the left and he had left ankle clonus. The lower abdominal and cremasteric reflexes were normal.[nature.com]
Limb Weakness
  • Clinical manifestations of thoracic spinal gout range from back pain, unilateral or bilateral extremities paralysis, limbs weakness, sensory impaired to urinary retention.[nature.com]

Workup

  • We would like to highlight here the difficult diagnostic workup in a patient with history of cancer and the presence of a tophus inside the liver.[ncbi.nlm.nih.gov]
  • Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test.[panafrican-med-journal.com]
  • Laboratory workup revealed leukocytosis (14.524/mm 3 ), elevated C-reactive protein (7.21 mg/dl) and elevated serum uric acid (14 mg/dl).[jmedicalcasereports.com]
Hepatocellular Carcinoma
  • We present the case of a 72-year-old man with a localization of gouty tophus in the liver, who thereafter developed a hepatocellular carcinoma (HCC) in the same site.[ncbi.nlm.nih.gov]
  • Case presentation We present the case of a 72-year-old man with a localization of gouty tophus in the liver, who thereafter developed a hepatocellular carcinoma (HCC) in the same site.[wjso.biomedcentral.com]

Treatment

  • Treatments with antibiotics and nonsteroidal antiinflammatory drugs were ineffective. However, prednisolone therapy was highly effective, and the patient's symptoms were rapidly ameliorated.[ncbi.nlm.nih.gov]
  • We have applied the percutaneous endoscopic technique for the treatment of spinal gout. It performed direct decompression with minimizing trauma and instability, which could be used as an alternative choice.[ncbi.nlm.nih.gov]
  • Surgical debridement is the mainstay of treatment for intraosseous tophus formation. Copyright 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • The patient regained strength in all extremities in the postoperative period and required rehabilitation treatment. Spinal gout should be considered in all patients presenting myelopathy and history of gout.[ncbi.nlm.nih.gov]
  • Clinical trials state that both pegloticase and febuxostat have been effective in the management of tophi, but treatment takes time. Occasionally, when medical treatment fails, surgical intervention becomes necessary to eliminate the tophi.[tandurust.com]

Prognosis

  • MRI Signal characteristics of gouty tophi are usually: T1: isointense T2 variable 4 the majority of lesions are characteristically heterogeneously hypointense T1 C (Gd): tophus often enhances Treatment and prognosis Acutely, gout can be managed with non-steroidal[radiopaedia.org]
  • Surgical decompression such as laminectomy followed by optimization of pharmacological treatment can improve the patient’s clinical symptoms and provide a good prognosis.[nature.com]
  • What Is the Prognosis for Gout? The prognosis for gout is excellent if you are properly diagnosed and treated. Gout and Diet Gout is a disease that results when crystals of uric acid form in tissues of the body.[emedicinehealth.com]
  • Association of SYT-SSX fusion types with proliferative activity and prognosis in synovial sarcoma. Mod Pathol 2000 May;13(5):482–8. [ CrossRef ] [ Pubmed ][ijcasereportsandimages.com]

Etiology

  • Moreover, we address the possible etiologic role of chronic inflammation related to tophi and liver cancer.[ncbi.nlm.nih.gov]
  • Thus, we presume that rupture of a gouty tophus or its surgical treatment might contribute to the occurrence of RS3PE syndrome; however, in our case, the etiology of the syndrome remained unknown.[ncbi.nlm.nih.gov]
  • Etiology: [2] Overproduction of uric acid 10% of cases. Reduced excretion of uric acid 90% of cases. May be genetic, e.g. URAT1 mutation. [3] [4] Renal failure. Treatments: [5] NSAIDs. Allopurinol. Colchicine - prophylatic.[librepathology.org]

Epidemiology

  • Epidemiology Gout affects approximately 5 million Americans and has historically been described as a disease that affects men; however, it also affects women.[dermaamin.com]
  • Epidemiology: [1] Male (Females relative risk 0.1). Renal failure. Diabetes mellitus. Etiology: [2] Overproduction of uric acid 10% of cases. Reduced excretion of uric acid 90% of cases. May be genetic, e.g. URAT1 mutation. [3] [4] Renal failure.[librepathology.org]
  • Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015;11:649–62. [2]. Forbess LJ, Fields TR. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi.[journals.lww.com]
  • New insights into the epidemiology of gout . Rheumatology (Oxford) 2009; 48 : ii2–ii8. 2. Hall AP , Barry PE , Dawber TR , McNamara PM . Epidemiology of gout and hyperuricemia. A long-term population study . Am J Med 1967; 42 : 27–37. 3.[nature.com]
  • Crystal arthritides - gout and calcium pyrophosphate arthritis: part 1: epidemiology and pathophysiology . Z Gerontol Geriatr. 2017 . DOI: 10.1007/s00391-017-1197-3 .[tandfonline.com]
Sex distribution
Age distribution

Pathophysiology

  • Crystal arthritides - gout and calcium pyrophosphate arthritis: part 1: epidemiology and pathophysiology . Z Gerontol Geriatr. 2017 . DOI: 10.1007/s00391-017-1197-3 .[tandfonline.com]
  • This process and the cell death associated with NETs (NETosis) likely evolved as a cellular strategy to counteract pathogens, but although scientists generally agree that it plays an important role in pathophysiology, they have found it difficult to quantify[the-rheumatologist.org]
  • […] and neutrophils followed by chronic gouty arthritis with tophi in joints and urate nephropathy Causes 2 - 5% of chronic joint disease Sites 50% have initial attack in first metatarsophalangeal joint; also ankles, heels, knees, wrists, fingers, elbows Pathophysiology[pathologyoutlines.com]
  • (See Pathophysiology and Etiology.) Gout is one of the oldest diseases in the medical literature, [1, 2] known since the time of the ancient Greeks.[emedicine.medscape.com]
  • Patients with serum urate levels 7 mg/dL have an annual incidence below 1%; for patients with serum urate levels 9 mg/dL, the incidence is more than 5%. 7 Pathophysiology Gout is an inflammatory crystal arthropathy resulting from the pathogenic effect[clevelandclinicmeded.com]

Prevention

  • The nasal bone defect was repaired with a titanium mesh plate to prevent nasal depression. He has fully recovered with no more nasal obstruction or recurrence of nasal tophus.[ncbi.nlm.nih.gov]
  • Large tophi should be removed to prevent any damage to your joint or loss of its range of motion.[healthline.com]

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