Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. A gouty tophus occasionally mimics an infectious or neoplastic process. However, the conventional enucleating procedure might... more
Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. A gouty tophus occasionally mimics an infectious or neoplastic process. However, the conventional enucleating procedure might cause complications. In severe cases, skin necrosis and tendon or joint exposure can occur after debridements. In this series, the soft-tissue shaver is used for deformity management of the chronic tophaceous patients and the results are encouraging. From November 2000 to August 2002, 17 patients with chronic tophaceous gout were treated by the shaver technique. Suction and irrigation were performed simultaneously while the shaver was operating, and chalky deposits of sodium urate could be removed efficiently. Skin necrosis was minimized by means of proper incision planning. Also, bedside debridements and wound wet dressing were helpful for improving the outcomes. The families and patients were satisfied with the results. In conclusion, severe chronic tophaceous gout can be a surgical challenge. The soft-tissue shaving technique can be useful for cosmetic debulking of large tophi in patients with advanced chronic tophaceous gouty arthritis.
We present a case of a patient with systemic gout disease who did not receive any treatments for 10 years. A seventy-one-year-old male came to our attention for physical weariness, chest discomfort, a mild fever for more than a month and... more
We present a case of a patient with systemic gout disease who did not receive any treatments for 10 years. A seventy-one-year-old male came to our attention for physical weariness, chest discomfort, a mild fever for more than a month and right knee pain. His blood test and laboratory data showed elevated white blood cell (WBC), uric acid (UA) and C-reactive protein (CRP). The bone scintigraphy showed increased radioactive tracer suggestive of multiple arthritis including axial skeleton. Whole body computed tomography (CT) scan showed multiple areas of bone erosion and tophi, especially in the sternoclavicular joints, sternocostal joints and facet joints of lumbar spine. Gouty arthritis typically affects the peripheral joints of the appendicular skeleton, especially feet and hands. Systemic gout disease affects not only the peripheral joints of the appendicular skeleton, but also the axial skeleton. Although joint aspiration is needed to detect monosodium urate (MSU) crystals, both scintigraphy and CT scan are powerful means to diagnose gouty arthritis at the same time.
