Spinal gout tophus
: a very rare cause of radiculopathy.
Painful bipartite patella secondary to a gouty tophus
was first reported by Hiroyuki Enomoto in 2006.
(6) Of the 32 knees, 26 had multiple lesions, while only 6 had a single isolated tophus
. The most common locations of deposition included the infrapatellar fat pad and anterior joint recess (87%), popliteal groove (78%), and intercondylar roof (69%).
Our patient had an ulcerated tophus
with skin necrosis on the first IPJ of right foot.
The ACR/EULAR 2015 gout classification criteria Pattern of Ankle or mid- Podagra (2) joint foot (1) involvement Characteristics One Two Three characteristic characteristics characteristics (1) (2) (3) * Erythema overlying the joint * Cannot bear touch or pressure * Difficulty walking/using the joint Time course of One typical Recurrent typical episode episode (1) typical (>2) episodes (2) * Maximal pain within 24 hours * Resolution of symptoms within 14 days * Complete resolution between attacks Clinical Present (4) evidence of a tophus
Serum uric acid <0.24 mmol- 0.36 - 0.48 >0.6 level L (-4) mmol/L (2) mmol/L (4) 0.48 - 0.60 mmol/L (3) Synovial fluid MSU negative analysis (-2) Imaging Present (4) * Ultrasound detection of tophi * X-ray: erosions
This novel xanthine oxidase inhibitor is indicated for the treatment of chronic hyperuricaemia in conditions where urate deposition has already occurred (including a history or presence of tophus
and/or gouty arthritis) .
Radiologic case study: Gouty tophus
involving the distal quadriceps tendon.
One may be tempted to think of Joseph's tophus
as purely incidental to the painting, as perhaps a deformity of the model's foot which Martini faithfully represented but which has no significance other than as a testament to the accuracy of his draughtsmanship.
He mentions tuff (tophus
), meagre gravel (glarea) and unctuous earth (pinguis gleba), further chalky soil (cretosa humus), potter's clay or "argilla" (creta qua utuntur figuli quamque nonnulli argillam vocant), coarse sand (sabulo), and ruddle / red ochre (rubrica).
(plural tophi): A hard deposit of crystalline uric acid that may appear as a lump just under the skin, particularly around the joints and at the rim of the ear.
In cases of prolonged hyperuricemia, it manifests itself as recurring episodes or disease with chronic tophus
or erosive arthritis.
However, poor control of hyperuricemia can result in a heavy tophus
in some cases [1-3].