Place of orthopedic surgery in gout

Öztürk, Recep; Atalay, İsmail Burak; Bulut, Emin; Beltir, Galip; Yılmaz, Selçuk; Güngör, Bedii Şafak

doi:10.5152/eurjrheum.2019.19060

Cited by 10 publications

(10 citation statements)

References 14 publications

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“…[34][35][36] Surgery can be challenging because of wound complications. 37,38 Ochoa et al 39 suggested that inflammatory changes of the lobular subcutaneous tissue can be triggered and perpetuated by the arterial blood supply disruption caused by the monosodium urate crystals thus rending tissue vulnerable to deposits. They also believed that some microtrauma of the walls of terminal blood vessels as well as communication loss between the vessels and the dermis occurred, making the tissue vulnerable.…”

Section: Discussionmentioning

confidence: 99%

Multiple Subcutaneous Gouty Tophi Even with Appropriate Medical Treatment: Case Report and Review of Literature

Erickson¹,

Assylbekova

Chong

2021

kjm

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INTRODUCTIONGout is one of the most common and complex causes of arthritis that can affect anyone. 1,2 It is one of the most ancient medical conditions known going back to references in Egypt in 2640 BC and Hippocrates writing about it in 400 BC. [3][4][5] Gout occurs when there are deposits of urate monosodium crystals in the synovial fluid and other tissues causing the inflammation and intense pain of a gout attack. Urate monosodium crystals usually are associated with longterm hyperuricemia that is triggered by several genetic factors as well as environmental factors such as the overconsumption of rich purine diets, alcohol, obesity, obesity-related disease, kidney disease, and certain medications. 1,[6][7][8][9][10][11][12][13] Risk factors for older patients include lowdose aspirin, alcohol abuse, decreased renal function, and prolonged use of diuretics. 14,15 Advanced gout, also known as gouty tophi, are large, visible (masses) made up of urate crystals. 5,16,17 The tophus is a cardinal sign and usually develops after 5-10 years of chronic undertreated gout with the olecranon bursa being one of the most affected areas. 5,16,17 Formation is caused by elevated serum uric acid levels due to neglected and poorly controlled gout. 18,19 Gouty tophi can develop anywhere. It can develop in periarticular soft tissues, sub-articular regions around bones, tendon sheaths, bursas, articular cartilage, and synovial tissues around flexor tendons. 17,20 Gouty tophi have been identified in vocal cords, myocardium, heart valves, eyes, spinal cord, pancreatic tail, breast, penis, with a propensity to affect the helix of the ear. 17,21,22 However, patients with multiple gouty tophi rarely are encountered because hyperuricemia can be treated effectively. The differential diagnosis of gouty tophi is broad, even though gout can be diagnosed clinically by elevated serum uric acid level; however, the concentration of serum uric acid may be within the normal limits and yet gouty tophi still can be developed. [23][24][25] This case was a patient who developed multiple gouty tophi over an extended period of time with increasing size of the masses while on medical treatment for his gout. The one mass of unique interest developed over the superficial anterior tibia just distal to the tibial tubercle and not in the patellar tendon, which is uncommon.

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Section: Discussionmentioning

confidence: 99%

Multiple Subcutaneous Gouty Tophi Even with Appropriate Medical Treatment: Case Report and Review of Literature

Erickson¹,

Assylbekova

Chong

2021

kjm

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“…A previous study demonstrated an alternative treatment for tophaceous ACL by performing continuous conservative management with allopurinol and narcotics, which substantially reduced the symptoms and shrunken the tophi deposition [9]. Ozturk et al mentioned that the primary treatment of tophaceous gout includes the continuous monitoring of serum uric acid level and controlling by administering urate-lowering medication, such as xanthine oxidase inhibitor [1]. e surgeon should be aware of similar pathologies and consider arthroscopic surgery if the mechanical symptoms persist, as this procedure can promptly provide a de nitive diagnosis and pain relief.…”

Section: Wwwjcorthcom Febyan Et Almentioning

confidence: 99%

“…Gout is an in ammatory disease characterized by the deposition of uric acid crystals in the joint tissues and synovial uids [1]. It presents in about 1% to 4% of the worldwide population, with a predominance of morbidity found more in women than men [2].…”

Section: Introductionmentioning

confidence: 99%

Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report

2021

JCOrth

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Gout is an inflammatory disease commonly characterized by tophus deposits containing uric acid crystals in the intraarticular joints. An acute locked joint due to gouty tophus formation is a rare finding. This case describes a 36-year-old man with sudden pain and locking in the knee joint. Physical examination, plain radiography, and serum uric acid examination showed unremarkable results. Further investigation with diagnostic arthroscopy confirmed tophaceous gout as the sole cause of an acutely locked knee. The patient exhibited satisfactory clinical results following surgical intervention under arthroscopy and the administration of urate-lowering agents. This case highlights the probability of tophus deposition as the cause of an acute locked knee, despite unremarkable initial presentation. The awareness regarding this case should be raised, especially on emphasizing arthroscopy as a cost-effective diagnostic and therapeutic modality in patient management.

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“…Although the administration of medications for controling the serum levels of uric acid and relieving specific symptoms is recommended as a first-line strategy for patients with chronic gouty arthritis, surgery is still an effective method for those with a large number of crystal deposits or those with joints exhibiting severe structural or functional effects [5,6]. Over recent years, arthroscopic debridement has become a common surgical method for the removal of crystals in multiple joints; this is due to the fact that arthroscopy is a less invasive approach, provides a greater visual field, and is associated with a reduced risk of complications and a faster duration of rehabilitation [7].…”

Section: Introductionmentioning

confidence: 99%

The application of a novel hydrodynamic cavitation device to debride intra-articular monosodium urate crystals

Cao

et al. 2023

BMC Surg

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Introduction Efficient and complete debridement of intra-articular deposits of monosodium urate crystals is rarely achieved by existing arthroscopic tools such as shavers or radiofrequency ablation, while cavitation technology represents a prospective solution for the non-invasive clearance of adhesions at intra-articular interfaces. Methods Simulation modeling was conducted to identify the optimal parameters for the device, including nozzle diameters and jet pressures. Gouty arthritis model was established in twelve rats that were equally and randomly allocated into a cavitation debridement group or a curette debridement group. A direct injection nozzle was designed and then applied on animal model to verify the effect of the cavitation jet device on the removal of crystal deposits. Image analysis was performed to evaluate the clearance efficiency of the cavitation device and the pathological features of surrounding tissue were collected in all groups. Results To maximize cavitation with the practical requirements of the operation, an experimental rig was applied, including a 1 mm direct injection nozzle with a jet pressure of 2.0 MPa at a distance of 20 mm and a nitrogen bottle as high-pressure gas source. With regards to feasibility of the device, the clearance rates in the cavitation group were over 97% and were significantly different from the control group. Pathological examination showed that the deposition of monosodium urate crystals was removed completely while preserving the normal structure of the collagen fibers. Conclusions We developed a promising surgical device to efficiently remove intra-articular deposits of monosodium urate crystals. The feasibility and safety profile of the device were also verified in a rat model. Our findings provide a non-invasive method for the intraoperative treatment of refractory gouty arthritis.

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Place of orthopedic surgery in gout

Cited by 10 publications

References 14 publications

Multiple Subcutaneous Gouty Tophi Even with Appropriate Medical Treatment: Case Report and Review of Literature

Multiple Subcutaneous Gouty Tophi Even with Appropriate Medical Treatment: Case Report and Review of Literature

Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report

The application of a novel hydrodynamic cavitation device to debride intra-articular monosodium urate crystals

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