Chronic tophaceous gout as the first manifestation of gout in two cases and a review of the literature

Gout Affecting the Nail Unit: Report of Two Cases and Literature Review

“…While this corresponded to a prevalence of 4.4% in the review, a previous study demonstrated an even higher rate at 16.2% of their cohort of patients with gout of less than 10 years [2]. This same study found colchicine use, diuretic use, and decreased creatinine clearance to be risk factors for early development of tophi [2, 3]. Identification of tophi in these populations is of great importance as the clinical presence of tophi alone is associated with rapid decline in creatinine.…”

“…In a recent case report and literature review by Bieber et al [2], the authors identified 36 cases and analyzed another study investigating 65 additional patients who presented with tophi as the initial manifestation of the gout. While this corresponded to a prevalence of 4.4% in the review, a previous study demonstrated an even higher rate at 16.2% of their cohort of patients with gout of less than 10 years [2]. This same study found colchicine use, diuretic use, and decreased creatinine clearance to be risk factors for early development of tophi [2,3].…”

“…While tophi are typically seen 10 or more years after initial gout flare, tophi have been reported to develop without an antecedent history of arthritic gout. In a recent case report and literature review by Bieber et al [2], the authors identified 36 cases and analyzed another study investigating 65 additional patients who presented with tophi as the initial manifestation of the gout. While this corresponded to a prevalence of 4.4% in the review, a previous study demonstrated an even higher rate at 16.2% of their cohort of patients with gout of less than 10 years [2].…”

Are interventions for treatment of tophi in gout efficient? – A Cochrane Review summary with commentary

“…If treated properly, flares can be prevented, joint damage related to tophi formation can be minimized and effective reduction of serum urate levels can prevent further crystal formation and dissolve existing urate crystals. 5 A recent meta-synthesis on gout flares performed by Stewart and colleagues showed that these may impact many aspects of patients' lives (physical and psychological and social and family life). 6 A study by Huang and colleagues tried to identify possible risk factors for ulceration(s) over tophi in gout patients and those include glucocorticoid overuse, prolonged duration with tophi and greater numbers of tophi.…”

“…Unusual sites of their appearance might include heart valves, carpal tunnel, larynx and spine. If treated properly, flares can be prevented, joint damage related to tophi formation can be minimized and effective reduction of serum urate levels can prevent further crystal formation and dissolve existing urate crystals 5 …”