Characteristics of ocular abnormalities in gout patients

·AIM: To characterize the clinical features of ocular surface in gout patients in coastal area of Shandong Province in China. ·METHODS: A total of 380 consecutive gout patients were examined from January 2011 to May 2011. According to the course of gout, patients were divided into group A (【5 years), B (5 -10 years) and C (】10 years). Group D (control group) was consist of 50 healthy subjects. Eyelids, lateral canthus, medial canthus, palpebral conjunctiva, sclera and cornea, anterior chamber, lens, anterior vitreous were examined by slit lamp to find whether there were deposition of uric acid crystals, ocular vascular tortuosity, redness and subconjunctival hemorrhage. The ophthalmic exams of visual acuity, intraocular pressure, fundus were used to assess any gout-related eye disease. ·RESULTS: Uric acid crystals were found in 3 patients and the positions of the deposite were in corneal stroma, corneal epithelium and superficial stroma, and sclera respectively. The incidence was 0.79% . Dilatated and tortuous blood vessels in conjunctiva and sclera surface were found in 38 (23.8% ), 40 (44.0% ), 58 (45.0% ), 9 (18.0% ) patients in groups A, B, C and D, respectively. The differences between group B and D, group C and D were statistically significant( 【0.01, 【0.01).Transparent vesicles with metal -like reflected light in subconjunctiva were seen in 26 (16.2%), 29 (31.9%), 41 (31.8%), 2 (4.00%) patients in groups A, B, C and D, respectively. The differences between A and D, B and D, C and D were statistically significant ( 【0.05, 【0.01, 【0.01). Subconjunctival hemorrhage was found in all groups, the difference among the four groups showed no statistically significance. · CONCLUSION: Gout can cause ocular surface abnormalities, such as tophi deposition, subconjunctival transparent vesicles and hemorrhage, and vascular changes. These features have important clinical significance in early detection of the gout and prevention of eye injury. ·

Spinal gout:A review with case illustration

AIM To summarize clinical presentations and treatment optionsof spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation.METHODS The authors reviewed 68 published cases of spinal gout, which were collected by searching "spinal gout" on Pub Med from 2000 to 2014. The data were analyzed for clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, and treatment choices. RESULTS Of the 68 patients reviewed, the most common clinical presentation was back or neck pain in 69.1% of patients. The most common laboratory study was elevated uric acid levels in 66.2% of patients. The most common diagnostic image finding was hypointense lesion of the gout tophi on the T1-weighted magnetic resonance imaging scan. The most common surgical treatment performed was a laminectomy in 51.5% and non-surgical treatment was performed in 29.4% of patients.CONCLUSION Spinal gout most commonly present as back or neck pain with majority of reported patients with elevated uric acid. The diagnosis of spinal gout is confirmed with the presence of negatively birefringent monosodium urate crystals in tissue. Treatment for spinal gout involves medication for the reduction of uric acid level and surgery if patient symptoms failed to respond to medical treatment.

Multiple gouty tophi in the head and neck with normal serum uric acid:A case report and review of literatures

BACKGROUND Gouty tophus is rarely reported in the head and neck areas.To the best of our knowledge,this is the first report on multiple gouty tophi in the head and neck with normal serum uric acid(SUA)levels.CASE SUMMARY We report a case of multiple gouty tophi in the nasal dorsal and auricle regions with normal SUA levels.The patient was admitted to the hospital with a chief complaint of recurrent nasal swelling and pain for 3 years,which was aggravated for 3 d.The patient’s SUA level had been regularly reviewed in the outpatient department and had been successfully controlled for several years.Resection of the nasal masses was performed.Cartilage from the right ear cavity was used to repair the nasal defects.The pathological report confirmed a nasal gouty tophus.No recurrence or deformity was found after a 1 year follow-up.CONCLUSION Normal SUA cannot completely negate the diagnosis of gouty tophus,especially in some rare regions.

Experience of VSD in the treatment of foot tophi rupture with severe infection wounds

Objective Investigate the clinical effects of Vacuum Sealing Drainage(VSD)in the treatment of 11 cases of foot tophi rupture with severely infected wounds.Methods From January 2017 to January 2019,11 patients with foot tophi rupture and severe infection were enrolled in our department.There were 9 males and 2 females,aged from 27 to 68 years old.All patients were treated with VSD after debridement.The treatment time was 7d-42d,with an average of 17d.Results All patients were followed up for 6 months after VSD treatment.All the wounds healed well without complications.Conclusion VSD is used to treat foot tophus rupture with severe infection of wounds.It is easy to operate and satisfactory in clinical results.

Osteochondral lesion of talus with gout tophi deposition:A case report

BACKGROUND Osteochondral lesion of talus is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone.It arises from diverse causes,and although trauma is implicated in many cases,it does not account for the etiology of every lesion.Gout is a chronic arthritic disease caused by excess levels of uric acid in blood.Intraosseous deposition of monosodium urate in the clavicle,femur,patella and calcaneus was reported previously.Gout is common disease but rare at a young age,especially during teenage years.Osteochondral lesion caused by intra-articular gouty invasion is very rare.CASE SUMMARY We encountered a rare case of a 16-year-old male who has osteochondral lesion of the talus(OLT)with gout.He had fluctuating pain for more than 2 years.We could see intra-articular tophi with magnetic resonance image(MRI)and arthroscopy.We performed arthroscopic exploration,debridement and microfracture.Symptoms were resolved after operation,and bony coverage at the lesion was seen on postoperative images.We had checked image and uric acid levels for 18 mo.CONCLUSION It is rare to see OLT with gouty tophi in young adults.While it is challenging,the accuracy of diagnosis can be improved through history taking,MRI and arthroscopy.

Sepsis complicated with secondary hemophagocytic syndrome induced by giant gouty tophi rupture: A case report

BACKGROUND Gouty tophi are a chronic granulomatous caused by a deposition of monosodium urate crystal deposition in the body.Once broken,it may easily induce severe infection.Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting,and no such serious complications have been reported in literature.CASE SUMMARY This is a 52-year-old Chinese male patient with a 20-year history of gouty arthritis.At admission,the gout stone in the patient’s right ankle was broken and it secreted a white mucoid substance.During the course of treatment,the patient suffered from systemic inflammatory response syndrome multiple times.His condition gradually deteriorated,further complicated by hemophagocytic syndrome.After thorough removal of gout lesions and active anti-infection treatment and control of blood uric acid level,combined with multidisciplinary cooperation,the patient was finally cured.CONCLUSION Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting.Timely and accurate diagnosis is very important to save patients'lives.

Determination of the microstructure and chemical composition of tophi

Objective:To explore the tophi in different parts of the human body of microstructure and main chemical components.To lay the foundation for further revealing the inflammatory response mechanism of gout patients.Methods:Use microscope,scanning electron microscope,etc.to observe the microstructure of tophi,and use scanning electron microscope energy spectrum analysis,X-ray fluorescence analysis,X-ray diffraction analysis,etc.to detect and analyze the main crystalline components and chemical elements of tophi.Results:Through HE staining and scanning electron microscopy,the tophi is irregular block shape and its interior is needle shaped and radial.The energy spectrum analysis showed that the main elements of tophi were C,N,O,Na,etc.X-ray fluorescence analysis was used to detect tophi in the knees,elbows,and feet,the main elements of tophi were Cl,S,Ca,P,etc.X-ray diffraction analysis showed that the main crystalline components of tophi were sodium urate hydrate and sodium dihydrogen urate hydrate.Conclusion:The mainly elements of tophi are C,N,O,Na,Ca,Cl,S,P,etc.The main crystalline components of tophi were sodium urate hydrate and sodium dihydrogen urate hydrate.

The Pathognomic Radiologic Features of Gout in the Fingers and Review of the Literature, Including the Latest Drug Therapy

Gout is one of the most common inflammatory arthritides that predominantly affects the first metatarsophalangeal joint. The underlying inflammatory process is elicited by the deposition of monosodium urate (MSU) crystals in the affected joint that are termed tophi and which may in the course of chronic gout progress into subcutaneous depositions of tophi. In this case report, we present a patient (PID: 6925981) who was seen in our outpatient department with a first episode of tophaceous gout in the finger, an infrequently seen condition that mostly affects older men with long-term gout. We discuss the case in view of the current literature on diagnosis and treatment of tophaceous gout.

Case of gout with inflammatory low back pain

A 50-year-old male patient with a history of chronic tophaceous gout presented with low back pain and bilateral shoulder,hip,knee,and buttock pain for 1 year.He had nocturnal exacerbations of buttock pain and significant early morning stiffness,which improved with nonsteroidal anti-inflammatory agents(NSAIDs).On examination,he had multiple hard,lobulated tophaceous deposits over the bilateral elbow,hand,leg,and foot.There was no ulcer or discharge from tophi(Figure 1A).He had restriction of movements in the lower back and bilateral positive faber test localized to the back.

Construction of an easy-to-use predictive model for ultrasound-detected tophi to improve the detection of hidden tophi

Background:Musculoskeletal ultrasound is used in clinical practice to evaluate gout patients and is an effective imaging tool for the detection of tophi.The aim of this study was to analyze the factors associated with ultrasound-detected tophi in gout patients and to construct a clinical model to predict its occurrence and improve the detection of hidden tophi.Methods:Data of gout patients admitted to Beijing Jishuitan Hospital from January 2015 to December 2021 were collected.The complete and detailed information from gout cases with completed musculoskeletal ultrasound was included in the analysis.Univariate and multivariate analyses were used to identify independent factors associated with ultrasound-detected tophi.A nomogram was used to visualize the clinical predictive models.Results:Among 517 gout patients,rheumatologists found that 67 patients(13.0%)had subcutaneous tophi by visual observation,while musculoskeletal ultrasound revealed that 123 patients(23.8%)had ultrasound-detected tophi with odds ratio[OR](95%confidence intervals[CIs])=2.20(1.81-2.67).Disease duration,upper limb joint flare(ULJF),persistent joint pain(PJP),uric acid,and homocysteine levels were independently associated with ultrasounddetected tophi,and they had ORs(95%CIs)of 1.092(1.050-1.136),3.732(2.312-6.025),1.864(1.086-3.200),1.003(1.001-1.004),and 1.015(1.000-1.030),respectively.After balancing the complexity and accuracy of the model,Model 2(incorporating disease duration,ULJF,PJP,and uric acid)was chosen to create a nomogram to predict the occurrence of ultrasound-detected tophi.The nomogram had good discrimination(consistency index[C-index]=0.774)and excellent calibration,demonstrated by calibration curves.Conclusion:Using easily available indicators,such as disease duration,the nature of the joint pain,and uric acid levels,we successfully developed an easy-to-use clinical model to improve the detection of hidden tophi.