Giant Gouty Tophi of the Hand and Wrist

Abstract

Gout is an inflammatory-rheumatic disease characterized by an elevated serum urate concentration and recurrent flares, including painful, hot, red, and swollen joints and surrounding tissue. Untreated gout often develops into a chronic disease with tophi and destruction of joint surfaces. Giant tophi are often resistant to medication and change in diet.This article presents a case of a 44-year-old man with giant gouty tophi at his hand and wrist. The last acute gout flare in his left wrist was approximately 3 years prior. For 2 years he had refused adequate nutrition, such as a low-purine diet, and had refused to take any preventive medication. Blood urate level was elevated to 8.7 mg/dL (normal range, 3.4-7.0 mg/dL). In time, the tophi led to a massive limitation of motion and use of especially the left wrist and thumb. Under the condition that the patient changed his diet and took the medication for his underlying disease, we surgically removed the almost skin-perforating tophi. Surgical debulking significantly improved joint function and cosmetic appearance.The best treatment for gouty tophi is prevention by ensuring adequate nutrition, treating the underlying causes, and taking effective medication. In the case of massive limitation of joint motion, skin breakdown with risk of infection, and compression of neurovascular structures, surgical debulking of the tophi should be considered.

Unusual Locked Trigger Finger Due to Tophaceous Infiltration of Wrist Flexor Tendon

“…The underlying metabolic disorder is hyperuricemia [4]. The most common primary cause is renal under excretion (90%) [5]. Some patients suffer from enzyme defects, which lead to overproduction of uric acid [5].…”

“…The most common primary cause is renal under excretion (90%) [5]. Some patients suffer from enzyme defects, which lead to overproduction of uric acid [5]. Dietary causes like high consumption of alcohol or purine-rich foods may also lead to hyperuricemia [5].…”

“…Some patients suffer from enzyme defects, which lead to overproduction of uric acid [5]. Dietary causes like high consumption of alcohol or purine-rich foods may also lead to hyperuricemia [5]. Other causes are rare genetic disorders, medical disorders (metabolic syndrome, renal failure, hemolytic anemia), and medication use [5].…”

“…Dietary causes like high consumption of alcohol or purine-rich foods may also lead to hyperuricemia [5]. Other causes are rare genetic disorders, medical disorders (metabolic syndrome, renal failure, hemolytic anemia), and medication use [5]. Approximately 10% of patients with elevated blood levels of uric acid develop gout at some point in their life [5].…”

“…Other causes are rare genetic disorders, medical disorders (metabolic syndrome, renal failure, hemolytic anemia), and medication use [5]. Approximately 10% of patients with elevated blood levels of uric acid develop gout at some point in their life [5]. In patients in whom the disease has been neglected tophaceous destruction of musculoskeletal structures may be helped by carefully selected surgical procedures [4].…”