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Dalbeth N, Botson J, Saag K, Kumar A, Padnick-Silver L, LaMoreaux B, Becce F. Monosodium urate crystal depletion and bone erosion remodeling during pegloticase treatment in patients with uncontrolled gout: Exploratory dual-energy computed tomography findings from MIRROR RCT. Joint Bone Spine 2024; 91:105715. [PMID: 38447697 DOI: 10.1016/j.jbspin.2024.105715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/19/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Monosodium-urate (MSU) crystal deposits can be visualized and quantified with dual-energy CT (DECT). Pegloticase lowers serum urate (SU) in uncontrolled gout patients, with methotrexate (MTX) co-therapy recommended to increase SU-lowering response rate and decrease infusion reaction risk. The literature on serial DECT-imaging during pegloticase+MTX co-therapy is sparse, with only 2 prior cases of rapid MSU deposition depletion with subsequent bone-erosion remodeling reported from a small open-label trial. Here, we report DECT findings during pegloticase treatment in a larger number of patients from a randomized controlled trial to confirm bone-erosion remodeling that follows MSU depletion with pegloticase. The influence of length-of-therapy is also explored. METHODS Patients received pegloticase (8mg every 2weeks)+MTX (15mg/week orally) or pegloticase+placebo (PBO) during the MIRROR RCT trial. A subset underwent DECT-imaging on Day1 (first pegloticase infusion) and at Weeks 14, 24, and 52. Patients with paired baseline-Week 52 images were included. Imaged regions with baseline MSU-crystal volume (VMSU)<0.5cm3 were excluded to minimize artifact contributions. VMSU and bone-erosion remodeling were assessed. RESULTS Eight patients (6 MTX, 2 PBO) were included. Included patients had received 52weeks (5 MTX), 42weeks (1 PBO), and 6weeks (1 MTX, 1 PBO) of pegloticase therapy. Patients who prematurely discontinued pegloticase maintained SU<6mg/dL on allopurinol (n=2)/febuxostat (n=1). At Week 52, VMSU had markedly decreased in both the pegloticase+MTX and pegloticase+PBO treatment groups, with faster depletion during pegloticase therapy. Bone-erosion remodeling was observed in 29/42 (69%) evaluated erosions: 29 (69%) size decrease, 4 (9.5%) recortication, 3 (7.1%) new bone formation. CONCLUSION Rapid VMSU depletion during pegloticase therapy was observed with concomitant bone remodeling within 1year. Following pegloticase discontinuation, VMSU reduction slowed or stopped even when SU was maintained<6mg/dL with oral ULT. CLINICAL TRIAL REGISTRATION NCT03994731.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, M&HS Building 507, 28 Park Ave. Grafton, 1023 Auckland, New Zealand
| | - John Botson
- Orthopedic Physicians Alaska, 3801 Lake Otis Parkway, 99508 Anchorage, AK, United States
| | - Kenneth Saag
- University of Alabama at Birmingham, 2000 6th Ave. South, Floor 3, 35233 Birmingham, AL, United States
| | - Ada Kumar
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States
| | - Lissa Padnick-Silver
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States.
| | - Brian LaMoreaux
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
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Huang Q, Liao X. Patellar gout: An important mimic of patellar tumor. Int J Rheum Dis 2023; 26:2330-2331. [PMID: 37654118 DOI: 10.1111/1756-185x.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Qi Huang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Liao
- Department of Endocrinology and Metabolic Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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3
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Zhang WZ. Uric acid en route to gout. Adv Clin Chem 2023; 116:209-275. [PMID: 37852720 DOI: 10.1016/bs.acc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Gout and hyperuricemia (HU) have generated immense attention due to increased prevalence. Gout is a multifactorial metabolic and inflammatory disease that occurs when increased uric acid (UA) induce HU resulting in monosodium urate (MSU) crystal deposition in joints. However, gout pathogenesis does not always involve these events and HU does not always cause a gout flare. Treatment with UA-lowering therapeutics may not prevent or reduce the incidence of gout flare or gout-associated comorbidities. UA exhibits both pro- and anti-inflammation functions in gout pathogenesis. HU and gout share mechanistic and metabolic connections at a systematic level, as shown by studies on associated comorbidities. Recent studies on the interplay between UA, HU, MSU and gout as well as the development of HU and gout in association with metabolic syndromes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular, renal and cerebrovascular diseases are discussed. This review examines current and potential therapeutic regimens and illuminates the journey from disrupted UA to gout.
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Affiliation(s)
- Wei-Zheng Zhang
- VIDRL, The Peter Doherty Institute, Melbourne, VIC, Australia.
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Ménez O, De Saint Aubain N, De Angelis R. Spontaneous Fracture of the Fifth Metatarsal Secondary to Gout Tophus in a Young Patient: A Case Report. Cureus 2023; 15:e40400. [PMID: 37456419 PMCID: PMC10347027 DOI: 10.7759/cureus.40400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Gout is a common disease, and its prevalence is increasing. After several years of untreated gout, in very rare cases tophi may cause a spontaneous fracture. This type of fracture may be difficult to distinguish from others, especially when gout is not yet diagnosed. We present a case of a pathological fracture caused by tophus in a young man, which led to the diagnosis of gout.
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Affiliation(s)
- Ophélie Ménez
- Radiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, BEL
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Case report of a tibial fracture in a patient suffering from gout: An atypical site, the importance of differential diagnosis. Radiol Case Rep 2022; 17:1180-1184. [PMID: 35169424 PMCID: PMC8829500 DOI: 10.1016/j.radcr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 11/20/2022] Open
Abstract
We present the case of a 60-year-old man with a history of severe tophaceous gout with polyarticular involvement who came to the emergency room due to direct trauma to the right forearm and knee. The knee X-ray and CT scan showed a lateral tibial plateau fracture characterized by the presence of a lytic bone lesion. The presence of a solid neoplasm was ruled out and a CT-guided biopsy was performed. Histological evaluation revealed findings typical for an advanced intraosseous gout. As there was no significant risk of progression of the lytic lesion, the fracture site was treated conservatively. This case is unique in the literature in terms of location and should be considered as an atypical site of intraosseous gout. Proper differentiation of a pathological fracture on an intraosseous gout location from a neoplastic lesion is essential to choose the correct therapy.
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6
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Huang Q, Wang P, Liao X. Pseudo-tumor of the patella due to gout tophi. Joint Bone Spine 2021; 89:105295. [PMID: 34655795 DOI: 10.1016/j.jbspin.2021.105295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Qi Huang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, China.
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, China
| | - Xin Liao
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, China
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Ferrández-Jiménez M, Calabuig I, Peral-Garrido ML, Gómez-Garberí M, Andrés M. Risk of osteoporotic thoracic vertebral fractures in patients with gout. ACTA ACUST UNITED AC 2021; 18:279-285. [PMID: 34294558 DOI: 10.1016/j.reumae.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Osteoporosis causes significant morbidity and mortality by the development of fragility fractures, including vertebral fractures. Patients with gout may show an increased risk of osteoporotic fractures, as accelerated bone resorption is likely linked to urate crystal-led inflammatory state. This study aims to evaluate the risk of osteoporotic dorsal vertebral fractures associated with gout. METHODS Cross-sectional study carried out in patients admitted for cardiovascular events. Patients with available lateral view of chest radiography (on admission or in the previous six months) were selected. Two observers blinded to clinical data reviewed the radiographies simultaneously. Vertebral fracture was defined as a vertebral height loss ≥20%, and presence, number, and severity (by Genant semi-quantitative scale) were registered. To analyse the relationship between gout and the presence of vertebral fractures, the odds ratio (OR) with 95% confidence interval (95%CI) was calculated by multiple logistic regression. RESULTS 126 patients were analysed, 21 of them (16.67%) suffered from gout. Eighteen cases with fractures were detected, with a prevalence of 14.3%. A significant association was found between gout and vertebral fracture (28.6% gout, 11.4% controls; OR 3.10, 95%CI 1.01-9.52). There were no differences in the number of fractures, while the severity was found to be higher in the controls. The association between gout and vertebral fracture persisted after multivariate adjustment (OR 5.21, 95% CI 1.32-20.61). CONCLUSION An independent association between gout and radiological thoracic vertebral fractures was revealed in patients with a cardiovascular event.
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Affiliation(s)
| | - Irene Calabuig
- Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - María-Luisa Peral-Garrido
- Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | | | - Mariano Andrés
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain; Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
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Ferrández-Jiménez M, Calabuig I, Peral-Garrido ML, Gómez-Garberí M, Andrés M. Risk of osteoporotic thoracic vertebral fractures in patients with gout. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00031-0. [PMID: 33642246 DOI: 10.1016/j.reuma.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/26/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Osteoporosis causes significant morbidity and mortality by the development of fragility fractures, including vertebral fractures. Patients with gout may show an increased risk of osteoporotic fractures, as accelerated bone resorption is likely linked to urate crystal-led inflammatory state. This study aims to evaluate the risk of osteoporotic dorsal vertebral fractures associated with gout. METHODS Cross-sectional study carried out in patients admitted for cardiovascular events. Patients with available lateral view of chest radiography (on admission or in the previous six months) were selected. Two observers blinded to clinical data reviewed the radiographies simultaneously. Vertebral fracture was defined as a vertebral height loss ≥20%, and presence, number, and severity (by Genant semi-quantitative scale) were registered. To analyse the relationship between gout and the presence of vertebral fractures, the odds ratio (OR) with 95% confidence interval (95%CI) was calculated by multiple logistic regression. RESULTS 126 patients were analysed, 21 of them (16.67%) suffered from gout. Eighteen cases with fractures were detected, with a prevalence of 14.3%. A significant association was found between gout and vertebral fracture (28.6% gout, 11.4% controls; OR 3.10, 95%CI 1.01-9.52). There were no differences in the number of fractures, while the severity was found to be higher in the controls. The association between gout and vertebral fracture persisted after multivariate adjustment (OR 5.21, 95% CI 1.32-20.61). CONCLUSION An independent association between gout and radiological thoracic vertebral fractures was revealed in patients with a cardiovascular event.
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Affiliation(s)
| | - Irene Calabuig
- Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
| | - María-Luisa Peral-Garrido
- Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
| | - Miguel Gómez-Garberí
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, España
| | - Mariano Andrés
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, España; Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España.
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Bernal JA, García-Campos J, Marco-LLedó J, Andrés M. Gouty Involvement of Foot and Ankle: Beyond Flares. REUMATOLOGIA CLINICA 2021; 17:106-112. [PMID: 32067922 DOI: 10.1016/j.reuma.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
The foot and ankle are common locations of deposition of monosodium urate (MSU) crystals, as indicated by the clinical manifestations presented by patients with gout, which are not limited to the acute inflammation of the big toe. We present a narrative literature review aimed to update the gout involvement of foot and ankle and how it affects the quality of life. Cumulative reports indicate that gout, even at the non-tophaceous stage, could cause pain, gait impairment and limit the mobility at lower limbs. These patients may present difficulties in some activities of daily living such as choosing footwear, thus leading to an impaired quality of life. Gout is a curable disease by dissolving MSU crystals but remains unclear how this could modify some of these foot and ankle manifestations, especially when structural damage has already occurred. Furthermore, a collaboration between rheumatologists and podiatrists seems helpful to understand, relieve these symptoms and improve the quality of life in gouty patients.
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Affiliation(s)
- José-Antonio Bernal
- Sección de Reumatología, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
| | - Jonatan García-Campos
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain
| | - Javier Marco-LLedó
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain
| | - Mariano Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
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Jeon YS, Hwang DS, Hwang JM, Lee JK, Park YC. Pathological Fracture of the Femoral Neck due to Tophaceous Gout: An Unusual Case of Gout. Hip Pelvis 2019; 31:238-241. [PMID: 31824879 PMCID: PMC6892900 DOI: 10.5371/hp.2019.31.4.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022] Open
Abstract
A 48-year-old man visited the emergency room with right hip pain that started abruptly while walking out of the bathroom. Computed tomography showed an intraosseous mass in the femoral neck. The patient had a 15-year history of gout and had numerous bilateral tophi in his hands, feet, knees, and elbows. After operation, we diagnosed a pathological fracture due to intraosseous tophi. Patients with hip pain who have many subcutaneous tophi and long-standing gout should be diagnosed carefully. Peri-hip joint pain caused by gout is uncommon, however, if a patient complains of pain, a simple X-ray may be required. If intraosseous tophi are present, appropriate treatment (e.g., strict hyperuricemia control with or without prophylactic internal fixation), may be required before fracture occurs.
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Affiliation(s)
- Yoo-Sun Jeon
- Department of Orthopaedic Surgery, Barun Mind Hospital, Daejeon, Korea
| | - Deuk-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jung-Mo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeong-Kil Lee
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young-Cheol Park
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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Fengbin Y, Lian C, Linan Z, Hui Z, Degang T, Jianbo J, Long G, Fei H. Pathologic Fracture of The Patella Secondary to a Gouty Tophus. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gout is a rare cause of patellar fracture, with few documented cases. We report a case of gout tophi in the patella, the severe transverse fracture resulting from minor trauma. The patient was managed by the same treatment principles used for patients with nonpathologic patella fractures. We preformed excising the mass, fixing the bone fragment and filling in bone defect with allograft bone. Union of the fracture was seen at three months follow-up. The patient has recovered completely and returned to his former work after 3 months postoperatively.
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12
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Zong Q, Hu Y, Zhang Q, Zhang X, Huang J, Wang T. Associations of hyperuricemia, gout, and UA-lowering therapy with the risk of fractures: A meta-analysis of observational studies. Joint Bone Spine 2019; 86:419-427. [DOI: 10.1016/j.jbspin.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
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Sinha S, Rijal R, Shah J, Chaudhary P. A Case of Surgically Intervened Chronic Tophaceous Gout and Review of Literature. J Orthop Case Rep 2019; 10:66-69. [PMID: 32547982 DOI: 10.13107/jocr.2019.v10.i01.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Gout is a disease of deposition of monosodium urate crystal in the body which commonly presents as an acute arthritis of the peripheral joints but can have varied presentation. It is mostly managed by dietary modifications and drugs, but surgery is rarely required for the management of urate crystals. Case Report We present a case of a 66-year-old male who intermittently presented to the outpatient with multiple tophi which was managed with lifestyle changes and medically; initially, the patient eventually required surgical excision for tophi in fingers and heel which improved the pain and morbidity of the patient. Conclusion Gout can be managed by lifestyle changes, medically by drugs, and in extreme cases surgically and requires the utmost compliance by the patient. Such surgical intervention is rare with the advent of uricosuric medication now.
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Affiliation(s)
- Siddhartha Sinha
- Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India
| | - Raju Rijal
- Department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Jitendra Shah
- Department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pashupati Chaudhary
- Department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Pathological Fracture of the Proximal Tibia from an Intraosseous Gouty Tophus: A Rare Presentation of Gout. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2017. [DOI: 10.1016/j.jotr.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Intraosseous gouty tophus as the cause of pathological fracture is a seldom encountered condition. Not only does the tophus lesion affect the bone, but recent literature has also demonstrated a correlation between bone health in relation to gout as a disease entity, and showed the importance of medical treatment to improve the bone quality in patients with gout. We present a rare case of a pathological fracture due to an intraosseous gouty tophus as the presentation of gout, which imposed a diagnostic challenge, and illustrates the importance of multidisciplinary management in such conditions.
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Mehta T, Bůžková P, Sarnak MJ, Chonchol M, Cauley JA, Wallace E, Fink HA, Robbins J, Jalal D. Serum urate levels and the risk of hip fractures: data from the Cardiovascular Health Study. Metabolism 2015; 64:438-46. [PMID: 25491429 PMCID: PMC4312534 DOI: 10.1016/j.metabol.2014.11.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Uric acid inhibits vitamin D activation experimentally and higher serum urate levels are associated with higher parathyroid hormone levels in humans suggesting a link between uric acid and bone health. We hypothesized that hyperuricemia may increase the risk of fractures in older adults. METHODS 1963 men and 2729 women ≥65 years of age who participated in the Cardiovascular Health Study and had baseline serum urate levels were included in the study. The primary outcome was incident hip fracture, assessed prospectively through June, 2008 by inpatient and outpatient records. The analysis was stratified by sex a priori. RESULTS There was a U-shaped relationship between serum urate levels and hip fractures in men. Men in the lowest and the highest urate quartiles (<4.88 and ≥6.88 mg/dL respectively) had a significantly higher rate of fractures in unadjusted analysis. However, upon multivariate adjustment, only the HR for hip fracture in highest quartile versus the reference remained significant (HR 1.9; 95% C.I. 1.1, 3.1; p value 0.02). High serum urate levels were not associated with hip fractures in women. CONCLUSION In this large prospective cohort of community-dwelling older adults, increased serum urate levels were associated with an increased risk of hip fractures in men. Further studies are needed to confirm these findings and to understand the mechanisms that underlie them.
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Affiliation(s)
- Tapan Mehta
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA
| | - Mark J Sarnak
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Erin Wallace
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Howard A Fink
- Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN
| | - John Robbins
- University of California Davis Medical Center, Sacramento, CA
| | - Diana Jalal
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO.
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de Parisot A, Ltaief-Boudrigua A, Villani AP, Barrey C, Chapurlat RD, Confavreux CB. Spontaneous odontoid fracture on a tophus responsible for spinal cord compression: a case report. Joint Bone Spine 2013; 80:550-1. [PMID: 23566667 DOI: 10.1016/j.jbspin.2013.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 02/18/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Audrey de Parisot
- Inserm UMR1033-Université de Lyon-Hospices Civils de Lyon, Department of rheumatology, Pavillon F, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
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Abstract
If left untreated, gout may result in radiographic abnormalities, that is, cartilage loss and periarticular osteopenia plus more-or-less gout-specific radiographic abnormalities: spurs, sclerosis, and periostal new bone formation. In the current issue, Dalbeth and colleagues describe findings from about 800 joints in 20 mostly tophaceous patients, which can help clinicians to identify osteopathologic gout: spurs, osteosclerosis, ankylosis and periostal new bone formation, all symptoms of advanced, untreated gout. These are hallmarks of chronic untreated gout and are to be prevented.
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Saketkoo LA, Garcia-Valladares I, Espinoza LR. Axial gout: cinderella of gouty arthropathy! J Rheumatol 2012; 39:1314-6. [PMID: 22753798 DOI: 10.3899/jrheum.120375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum 2012; 42:146-54. [PMID: 22522111 DOI: 10.1016/j.semarthrit.2012.03.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/07/2012] [Accepted: 03/18/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Gout is typically described as an inflammatory arthropathy that affects the peripheral joints. Our aim was to describe atypical and rare clinical presentations of gouty tophi to help increase physician awareness and aid in patient care. METHODS The relevant English literature of unusual gout manifestations was searched using the keywords gout, toph*, monosodium urate, uric acid, unusual, and rare. Well-described case reports, case series, and review articles were evaluated and included, if relevant, in the literature review. RESULTS Review of the literature revealed many unusual manifestations of gouty tophi involving the head and neck, skin, viscera, bones, tendons, ligaments, nerves, and axial skeleton. Transplant recipients, women, and elderly people are particularly susceptible to developing tophi. Furthermore, gout can cause diagnostic dilemmas, as it can be a great mimicker of and can coexist with infection, malignancy, and other connective tissue diseases. Imaging modalities can help detect tophi in atypical locations. CONCLUSIONS Tophi can present in unexpected locations, even as the first sign of gout, and vigilance is required when unusual symptoms or signs occur in a patient with gout.
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Bolzetta F, Veronese N, Manzato E, Sergi G. Tophaceous gout in the elderly: a clinical case review. Clin Rheumatol 2012; 31:1127-32. [DOI: 10.1007/s10067-012-1956-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
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Falidas E, Rallis E, Bournia VK, Mathioulakis S, Pavlakis E, Villias C. Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report. J Med Case Rep 2011; 5:397. [PMID: 21854566 PMCID: PMC3170636 DOI: 10.1186/1752-1947-5-397] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 08/19/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Gout is a common inflammatory arthritis caused by articular precipitation of monosodium urate crystals. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints, such as wrists, elbows, knees and ankles. Case presentation We report the case of a 75-year-old Caucasian man with tophaceous multiarticular gout, soft-tissue involvement and ulcerated tophi on the first metatarsophalangeal joint of the left foot, on the first interphalangeal joint of the right foot and on the left thumb. Conclusion Ulcers due to tophaceous gout are currently uncommon considering the positive effect of pharmaceutical treatment in controlling hyperuricemia. Surgical treatment is seldom required for gout and is usually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction.
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Affiliation(s)
- Evangelos Falidas
- First Department of Surgery, 417 NIMTS Veterans Administration Hospital of Athens, Monis Petraki 10-12, Athens, 11521,Greece.
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Chadwick CM, Saxby TS. Gout associated with fracture of the fifth metatarsal shaft: a case report. Foot Ankle Int 2011; 32:826-9. [PMID: 22049871 DOI: 10.3113/fai.2011.0826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: V, Expert Opinion
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Affiliation(s)
- Carolyn M Chadwick
- Brisbane Private Hospital, Brisbane Foot and Ankle Centre, 259 Wickham Terrace, Brisbane, Queensland 4000, Australia.
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Current World Literature. Curr Opin Rheumatol 2011; 23:219-26. [DOI: 10.1097/bor.0b013e3283448536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barg A, Knupp M, Kapron AL, Hintermann B. Total ankle replacement in patients with gouty arthritis. J Bone Joint Surg Am 2011; 93:357-66. [PMID: 21325587 DOI: 10.2106/jbjs.j.00957] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Gout is the most common cause of inflammatory arthritis in men and older women. The purpose of this review was to assess prosthetic component stability, postoperative pain relief, functional outcome, and quality of life of patients with gouty ankle arthritis who were treated with total ankle replacement. METHODS Sixteen patients (nineteen ankles) with chronic gout and a mean age (and standard deviation) of 65.2 ± 5.5 years were treated with a non-constrained three-component total ankle arthroplasty because of painful ankle arthritis. The average duration of follow-up was 5.1 ± 2.5 years. Component stability was assessed with use of weight-bearing radiographs. Clinical outcomes were analyzed with use of a visual analogue scale (VAS) for pain, a 36-item short-form health survey (SF-36), and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. RESULTS There were no intraoperative complications. In one patient, both arthroplasties were revised 4.7 years postoperatively because of painful prosthetic loosening. The average VAS score for pain decreased significantly from 7.5 ± 1.8 (range, 5 to 10) to 1.2 ± 1.3 (range, 0 to 3) (p < 0.001). All eight categories of the SF-36 score showed significant improvement (all p < 0.001). The average AOFAS hindfoot score increased significantly from 38 ± 15 (range, 15 to 77) preoperatively to 75 ± 13 (range, 54 to 92) postoperatively (p < 0.001). CONCLUSIONS Total ankle replacement in patients with painful gouty ankle arthritis is associated with a low risk of intraoperative and postoperative complications and leads to significant pain relief, high patient satisfaction, and good functional results.
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Affiliation(s)
- Alexej Barg
- Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
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Choe JY, Lee GH, Kim SK. Radiographic bone damage in chronic gout is negatively associated with the inflammatory cytokines soluble interleukin 6 receptor and osteoprotegerin. J Rheumatol 2010; 38:485-91. [PMID: 21159831 DOI: 10.3899/jrheum.100727] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated the risk factors for radiographic bone damage to foot joints in patients with chronic gout among various patient characteristics and serum inflammatory cytokines such as interleukin 1ß (IL-1ß), IL-6, soluble IL-6 receptor (sIL-6R), osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL). METHODS Fifty consecutive male patients with gout and 54 age-matched healthy male controls were enrolled. Serum levels of cytokines including IL-1ß, IL-6, sIL-6R, OPG, and RANKL were measured using ELISA. Radiographic damage indices including erosion scores, narrowing scores, and total scores for foot joints were assessed according to a modified Sharp-van der Heijde system. RESULTS There were significant differences in serum IL-1ß, IL-6, sIL-6R, OPG, and RANKL levels between patients with gout and the controls, after adjustment for confounding factors such as age, body mass index, blood urea nitrogen, creatinine, triglyceride, and fasting blood glucose (p = 0.034 for IL-1ß, p < 0.001 for IL-6, p = 0.040 for sIL-6R, p = 0.002 for OPG, and p = 0.018 for RANKL). Radiographic damage indices (erosion, narrowing, and total scores) were negatively associated with serum sIL-6R and OPG levels in multivariable-adjusted regression analysis. Serum sIL-6R levels in patients without radiographic damage were higher than in those with damage (p = 0.006). CONCLUSION Radiographic damage in patients with chronic gouty arthritis was negatively associated with serum sIL-6R and OPG. Further study on the role of inflammatory cytokines in the pathogenesis of radiographic damage in gout is needed.
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Affiliation(s)
- Jung-Yoon Choe
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu 705-718, South Korea
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