Clinical characteristics of infectious ulceration over tophi in patients with gout

Xu, Jianjun; Zhu, Zaihua; Zhang, Wei

doi:10.1177/0300060518761303

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Gout is a rheumatic disease resulting from deposition of monosodium urate crystal within joints due to long-lasting hyperuricaemia (Richette & Bardin, 2010). Due to prolonged and uncontrolled hyperuricaemia, tophi, a form of monosodium urate crystal, deposits in joints, tendon sheaths, soft tissues and bony prominences, causing negative effects on musculoskeletal function (Rider & Jordan, 2010;Xu, Zhu, & Zhang, 2018). The finding from this current research is similar to findings of past studies by Spaetgens et al (2017), in which gout was found to be associated with pneumonia and urinary tract infection.…”

Section: Discussionmentioning

confidence: 99%

Validation of predictive factors for infection in adults with chronic leg ulcers: A prospective longitudinal study

Bui

Finlayson

Edwards

2020

Journal of Clinical Nursing

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Aims and objectives To validate the ability of factors to predict infection in adults with chronic leg ulcers over a 12‐week period. Background Leg ulcers affect ~3% of older adults and are often hard to heal. Infection is a leading contributor for delayed healing, causing delayed wound healing, increased hospitalisation, increased healthcare costs and reduced patient quality of life. The importance of early identification of infection has been highlighted for decades, yet little is known about factors that are associated with increased risk of infection in this specific population. Design A longitudinal, prospective observational study in a single centre. Methods Between August 2017 and May 2018, a total of 65 adults with chronic leg ulcers were prospectively observed for a 12‐week period. Patients were recruited from an outpatient wound clinic at a tertiary hospital in Australia. Data were collected from recruitment (baseline) and each visit (weekly or fortnightly) up until 12 weeks. Descriptive statistics were calculated for all variables. A Cox proportional hazards regression model was used to identify predictive factors for infection. The TRIPOD guidelines for reporting were followed (See Data S1). Results The sample consisted of 65 adults with chronic leg ulcers, and 9.2% of these had their ulcer infected at baseline. Two predictive factors, using walking aids and gout, were found to be significantly related to increased likelihood of developing infection within 12 weeks. Conclusion The present study showed that patients who either used walking aids or were diagnosed with gout were at greater risk of infection compared to those without these factors. Relevance to clinical practice These findings provide new information for clinicians in early identification of patients at risk of infection, and for patients in enhancing their awareness of their own risk.

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Section: Discussionmentioning

confidence: 99%

Validation of predictive factors for infection in adults with chronic leg ulcers: A prospective longitudinal study

Bui

Finlayson

Edwards

2020

Journal of Clinical Nursing

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“…Polyarticular arthritis is more common with chronic tophaceous gout [ 7 ]. Chronic tophaceous gout develops in approximately 10 years in untreated patients, and 12–35% develops tophi [ 8 , 9 ]. Diagnosis is usually clinical, but synovial fluid analysis for monosodium urate crystal is gold standard.…”

Section: Discussionmentioning

confidence: 99%

Rare Presentation of Disseminated Gout Nodulosis and Chronic Inflammatory Arthritis

Sami

Arora

2023

Case Reports in Rheumatology

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Background. Gout is an inflammatory arthritis caused by monosodium urate (MSU) deposition. Acute gout is a dramatic painful swelling of the joint; however, MSU can deposit in other tissues as well, including skin, gastrointestinal tract, and bones over time. Disseminated tophi in the skin are a rare presentation of gout known as gout nodulosis. We present a case of gout nodulosis with subcutaneous diffuse miliary nodules in nonarticular areas with concurrent findings suggestive of chronic inflammatory arthritis. Case Presentation. A 39-year-old patient presented with intermittent painful swelling in multiple joints with prolonged morning stiffness. On exam, synovitis was present in multiple proximal interphalangeal joints, wrists, elbows, and knees. Chronic raised pearly nodular rash and swellings on extensor aspects of arms, legs, and anterior abdomen were noticeable. He had negative rheumatoid factor and anti-CCP antibody, C-reactive protein of 0.23 mg/dL, erythrocyte sedimentation rate of 37 mm/hr, and uric acid of 10.6 mg/dL. Hand X-rays revealed severe periarticular osteopenia and joint space narrowing in several joints. Musculoskeletal ultrasound showed a double contour sign at multiple joints and a tophaceous deposit over the olecranon fossa. The biopsy of the nodular rash was consistent with tophi. He was diagnosed with chronic tophaceous gout with skin nodulosis and possible overlap of seronegative rheumatoid arthritis given his X-ray findings. Conclusion. This case discusses one of the rare presentations of gout with disseminated gouty tophi in the skin to raise clinical awareness. The clinical dilemma of the overlap of gout and rheumatoid arthritis posing a diagnostic challenge for clinicians is also highlighted.

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“…The trauma history may provide a hint to possible causative microorganisms (Table 1). A gout tophus that is infected and perforates into the joint [26], or adjacent severe skin and softtissue infection [27,28], are less frequently reported routes of exogenous infections.…”

Section: Septic Arthritismentioning

confidence: 99%

Bone and joint infections of the hand

Sendi

Kaempfen

Uçkay

et al. 2020

Clinical Microbiology and Infection

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Background: Little guidance is currently available for standardized diagnostic protocols and therapeutic recommendations for bone and joint infections (BJIs) of the hand. Objectives: To summarize the available data in the scientific English-language literature on the diagnosis and treatment of native BJIs of the hand. To illustrate these concepts from a narrative point of view in areas where there is lack of evidence. Sources: We performed a systematic PubMed and Internet search of studies that investigated hand BJIs in adult patients. Content: Few studies have systematically investigated and validated diagnostic concepts, classifications or surgical treatment protocols. Most concepts derive from traditional intra-institutional experience, expert opinions and extrapolations from infections in large joints and long bones. Similarly, there is no uniformly accepted infection definition of BJIs of the hand. The best-documented literature is available for microbiological findings and antibiotic treatment duration in uncomplicated native joint arthritis of the fingers. Retrospective studies and one prospective randomized trial suggest that post-surgical targeted antibiotic therapy of 2 weeks results in a microbiological cure rate of 88%. Implications: Studies on diagnostic workup and infection definition and classification are urgently needed to compare inter-institutional outcome results and generate guidelines for the best patient care. For uncomplicated pyogenic arthritis of native joints, current evidence suggests that a 2-week course of antibiotic therapy following surgery cures the infection.

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Clinical characteristics of infectious ulceration over tophi in patients with gout

Cited by 5 publications

References 21 publications

Validation of predictive factors for infection in adults with chronic leg ulcers: A prospective longitudinal study

Validation of predictive factors for infection in adults with chronic leg ulcers: A prospective longitudinal study

Rare Presentation of Disseminated Gout Nodulosis and Chronic Inflammatory Arthritis

Bone and joint infections of the hand

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