GoutThe Broad Spectrum of Urate Crystal Deposition: Unusual Presentations of Gouty Tophi
Section snippets
Materials and Methods
We performed a literature search in the PubMed and EMBASE databases to identify unusual manifestations of gout. The search was limited to publications in English and from 1965 through 2011. The database search was conducted using the following terms: toph* AND gout OR toph* AND monosodium urate; OR toph* AND uric acid. The computerized search was completed with a manual search of pertinent reference lists from the relevant articles retrieved. The 2 databases (PubMed and EMBASE) were then
Typical Localization
Tophi generally form in or close to joints, in the subarticular regions of bone, in bursae, tendon sheaths, and articular cartilage. Aspirations of articular joints often demonstrate, on gross inspection, collections of white chalky substances floating in synovial fluid that are consistent with tophi. Tophi can erode underlying bone and produce typical “punched out” lytic lesions with overhanging edges of bone, which is one of the radiologic hallmarks of gouty arthropathy. Crystal deposition is
Transplant
Hyperuricemia and gout are prevalent in organ transplant recipients, and these patients have an accelerated clinical course when compared with the classic progression of gout (90). In addition to common risk factors for gout, calcineurin inhibitors (cyclosporine and to a lesser degree tacrolimus), which are used as anti-rejection medications, pose an additional risk in this population. The mechanism by which these medications results in hyperuricemia is complex and poorly understood, but
Gout as a Great Mimicker
Gout can deposit in unusual sites and mimic tumors with reports including deposits in the skin and muscles simulating soft tissue tumors, hyperkeratotic periungual lesions, and laryngeal deposits appearing as squamous cell carcinoma, tophi imitating intra-articular synovial tumors of the knee, intraosseous gout seeming to be bone tumors, spinal gout looking like metastatic disease, and internal organ involvement appearing to be malignancies of the pancreas and colon (15, 50, 51, 101, 102, 103,
Diagnostic Imaging for Early Detection
Conventional radiography has traditionally been used to detect calcified tophi and erosions with sharp margins and overhanging edges that are characteristic of gout. Erosions, however, are not always clear on plain radiography and tophi are not always calcified. Other imaging modalities, such as CT, magnetic resonance imaging (MRI), and ultrasound (US), can assist in the diagnosis of gout if conventional radiography is inconclusive or unrevealing, as they detect tophi and erosions at greater
Acknowledgments
The authors would like to thank Dr Michael Klein, director of Laboratory Medicine, Hospital for Special Surgery, and Dr Hollis Potter, director of magnetic resonance imaging, Hospital for Special Surgery, for their assistance in selecting appropriate images for this article.
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2021, Revue du Rhumatisme (Edition Francaise)Gouty Involvement of Foot and Ankle: Beyond Flares
2021, Reumatologia ClinicaCitation Excerpt :The monosodium urate (MSU) crystals deposition occurs in the musculoskeletal (MSK) system, as is demonstrated by the overt manifestations (flares, tophi) suffered by gout patients. However, the deposition and clinical picture probably is more generalized.4 Feet are major MSK sites of MSU crystal deposition, but there are other frequent locations such as knee, wrist, fingers or elbow bursae.
Tophaceous gout of the middle ear
2019, Journal of OtologyTophaceous gout of the shoulder joint
2019, Reumatologia Clinica
Theodore Fields, MD, serves on the Advisory Board and Speakers' Bureau for Takeda, Savient, and URL Pharmaceuticals.