Polyarticular tophaceous gouty arthritis: A case report

Abstract

Introduction: Gout is a disorder of purine metabolism, affecting men 40-50 years of age resulting in recurrent bouts of arthritis and subcutaneous tophi in patients with long standing disease. We report a case of a 45-year-old male with symmetric, deforming polyarticular arthritis, affecting all the joints of hands, wrists and feet with diffuse subcutaneous nodules over his body. the radiographic findings of the patient were atypical. Following clinical evaluation and additional investigations, the patient received a diagnosis of chronic tophaceous gouty arthritis mimicking rheumatoid arthritis.

Young Onset Polyarticular Tophaceous Gout: Rare and Aggressive

“…In about 10% of patients, the disease may initially arise as gouty tophus [1]. Uric acid elevating drugs, genetic predisposition, other systemic illnesses and predisposing dietary factors, such as high protein diet and alcohol consumption, have been attributed to the development of gout and its symptoms [4,[6][7][8]. However, older age, male sex, the postmenopausal state in women, and comorbidities such as renal disease, diabetes, or concomitant use of diuretics pose a higher risk [4].…”

“…Uric acid elevating drugs, genetic predisposition, other systemic illnesses and predisposing dietary factors, such as high protein diet and alcohol consumption, have been attributed to the development of gout and its symptoms [4,[6][7][8]. However, older age, male sex, the postmenopausal state in women, and comorbidities such as renal disease, diabetes, or concomitant use of diuretics pose a higher risk [4]. Progression to chronic phase over time, painful polyarticular attacks, tophi formation in soft tissues and joints followed by complications such as disability and joint deformities are the consequences of poor control and frequent neglect of the condition despite major progress in its management [1,6,8].…”

“…Synovial fluid or tophus aspiration provides the most accurate diagnosis through visualization of needleshaped negatively birefringent MSU crystals to differentiate from rhomboid weak positively birefringent crystals of calcium pyrophosphate dihydrate (CPPD) using polarizing microscopy and continues to be the gold standard for diagnosis of gout [1,4,7].…”

“…Management includes non-steroidal anti-inflammatory drugs (NSAIDs), allopurinol, corticosteroids, dietary and lifestyle modifications [1,4,7]. Acute attacks may sometimes resolve spontaneously without treatment and surgical treatment, although seldom required for gout, is usually reserved for cases of recurrent attacks with deformities and joint destruction [1,7,8].…”

“…Chronic tophaceous gout commonly occurs 10 years or more after the first acute episode [1,4]. We report an aggravated case of young-onset chronic tophaceous gout, which was diagnosed primarily on fine needle aspiration cytology (FNAC), thus emphasizing the consequences of lack of treatment and poor control of the condition.…”