Gout and Tophi

Recently, December 2015,  I saw a patient, 48-year-old male, with very evident masses on the surface of his joint areas – upper and lower extremities (elbows, hands, knees, feet).

When I saw these masses, based on pattern recognition, nodular masses around the joints, I thought right away of tophi resulting from gout.  Tophi are nodules under the skin around  a joint that contain urate crystal deposits.

He has this condition for the past 10 years already.

He claimed his father has such a condition also.

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Gout – Excerpts from University of Virginia Health System

Definition

Gout occurs when uric acid crystals build up in the joints. This causes the joints to be inflamed, causing pain.

Causes

Gout typically occurs if you have high levels of uric acid in your blood. A high level of uric acid in the blood is identified by the term hyperuricemia. However, you could also have normal uric levels and still have gout.

The uric acid can then form crystals in the joints causing the pain and inflammation.

 

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The liver metabolizes uric acid, and the kidneys get rid of it through the urine. Levels of uric acid build up when:

  • Too much uric acid is produced
  • Not enough uric acid is eliminated

If you have gout and hyperuricemia, your body doesn’t eliminate enough uric acid.

Certain foods and beverages may also increase your chances of gout.

  • Foods high in purines, such as organ meats, shellfish, some vegetables, and gravies.
  • High-fructose drinks, such as sugar-sweetened sodas and orange juice
  • Excess alcohol, especially beer
  • Binge drinking alcohol

Prevention

To help reduce your chance of getting gout:

  • Eat a low-purine diet.
  • Limit how much alcohol you drink. Avoid binge drinking.
  • Drink a lot of fluids.
  • Lose weight gradually.

http://uvahealth.com/services/autoimmune-rheumatology/autoimmune-rheumatic-conditions/gout

Gout – Excerpts from Mayo Clinic

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

Causes:

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Risk Factors:

Main risk factors are diet and family history.

Diet. Eating a diet that’s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.

Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.

Complications:

  • Recurrent joint  pain
  • Destruction of joints
  • Tophi formation: deposits of urate crystals to form under the skin in nodules called tophi.  Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
  • Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones.

Medications:

Medications to treat gout attacks

Drugs used to treat acute attacks and prevent future attacks include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Colchicine

Medications to prevent gout complications

Options include:

  • Medications that block uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood’s uric acid level and reduce your risk of gout.
  • Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys’ ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.

Surgical Treatment:  Reserved for kidney stones

Prevention:  
  • Keep your fluid intake high. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.
  • Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
  • Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
  • Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.

http://www.mayoclinic.org/diseases-conditions/gout/basics/complications/con-20019400

 

ROJ@15dec27

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