In patients with severe gout (such as tophi
, chronic arthritis, and frequent attacks), the serum urate level should be controlled more strictly with a target value <300 [micro]mol/L but lowering the level to <180 [micro]mol/L is not recommended.
Yu and colleagues (3) described a series of seven patients with limited knee ROM secondary to gouty tophi
At baseline, patients with clinically apparent tophi
had more tender and swollen joints, greater disability, and greater arthritis severity, but otherwise their clinical presentation was similar to patients without clinically apparent tophi
For now, providers should know that "patients with gout are not well served if their serum urate levels remain elevated, as that means they are at ongoing risk for flares and tophi
Magnetic resonance imaging (MRI) of the left elbow joint revealed tophi
compressing the ulnar nerve (Figure).
These criteria increase their specificity but make them less useful in diagnosing a first episode of gout, when tophi
are unlikely to have developed.
Our experience indicates that DECT may be a good choice for the diagnosis of CTS associated with gouty tophi
When one includes podagra and the presence of tophi
, the specificity increases.
Antonie van Leeuwenhoek, best known for his work on the improvement of the microscope, depicted in 1679 the crystals in the gouty tophi
, although their chemical composition was not yet known at that moment.
Frequent recurrently attacks of acute gout with the presence of tophi
or signs of gouty arthritis may call for long term treatment.
Gout presents as arthropathy, tenosynovitis, bursitis, and cellulitis of noninfectious origin, urinary tract calculi, and very commonly as soft-tissue deposits known as tophi
Diffuse calcinosis and intradermal tophi
in a uremic pateint: effect of low-calcium hemodialysis and mechanism of hypercalcemia.