Gout nodulosis: Widespread subcutaneous deposits without gout

Antonio, Iglesias G.; Londoño, Juan Carlos; Saaibi, Diego Luis; Peña, Mario Aguilera; Lizarazo, Humberto; González, Emilio B.

doi:10.1002/art.1790090113

Cited by 29 publications

(3 citation statements)

References 31 publications

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“…Tophi can also develop without a concomitant arthritis. Some authors used the term 'gout nodulosis' to describe the subcutaneous deposits of MSU in the absence of initial manifestation of gouty arthritis (8). Tophi may also develop over osteoarthritic Heberden's (Figure 4) or Bouchard's nodes in the distal and proximal interphalangeal joints, especially in older women often treated with diuretics (9).…”

Section: N Intercritical Goutmentioning

confidence: 99%

Clinical features of gout

Grassi¹,

Angelis²

2012

Reumatismo

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Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate (MSU) crystals in the joints and soft tissues, consisting of a self-limited acute phase characterized by recurrent attacks of synovitis and a chronic phase in which inflammatory and structural changes of the joints and periarticular tissues may lead to persistent symptoms. Acute gout is characterized by a sudden monoarthritis of rapid onset, with intense pain, mostly affecting the big toe (50% of initial attacks), the foot, ankle, midtarsal, knee, wrist, finger, and elbow. Acute flares also occur in periarticular structures, including bursae and tendons. The presence of characteristic MSU crystals in the joint fluid, appearing needle-like and showing strong negative birefringence by polarized microscopy, is pivotal to confirm the diagnosis of gout. The time interval separating the first attack from subsequent episodes of acute synovitis may be widely variable, ranging from a few days to several years. During the period between acute attacks the patient is asymptomatic even if MSU deposition may continue to increase silently. The factors that control the rate, location, and degree of ongoing deposition in gouty patients are not well defined. Chronic gout is the natural evolution of untreated hyperuricemia in patients with gouty attacks followed by pain-free intercritical periods. It is characterized by the deposition of solid MSU crystal aggregates in a variety of tissues including joints, bursae and tendons. Tophi can occur in a variety of locations including the helix of the ear, olecranon bursa, and over the interphalangeal joints. Their development is usually related with both the degree and the duration of hyperuricemia. About 20% of patients with gout have urinary tract stones and can develop an interstitial urate nephropathy. There is a strong association between hyperuricaemia and the metabolic syndrome (the constellation of insulin resistance, hypertension, obesity and dyslipidaemia), and gouty patients often have a medical history of kidney disease, diabetes mellitus and signs of vascular illness such as coronary artery disease, heart failure and stroke, resulting with a poor overall quality of life.

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Section: N Intercritical Goutmentioning

confidence: 99%

Clinical features of gout

Grassi¹,

Angelis²

2012

Reumatismo

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“…In some cases, a chalky substance drained from the ulcer. Skin involvement occasionally preceded articular symptoms [ 79 ]. On histopathology, inflammatory cells were often seen adjacent to MSU deposits.…”

Section: Resultsmentioning

confidence: 99%

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Khanna

Johnson

Marder

et al. 2020

JCM

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Gout, an inflammatory arthritis, affects over nine million people in the US with increasing prevalence. Some medical societies do not recommend treating gout unless it is recurrent. While soft tissue urate deposits (tophi), resultant bone erosions, and joint inflammation are frequently recognized in gout, urate crystal deposits in other sites have been thought to be rare. Recent diagnostic testing, such as dual energy computed tomography (DECT), has led to the recognition that urate deposits are not uncommon in other tissues including the vasculature. To understand the potential risks for untreated gout, we reviewed the literature on extra-articular urate deposition documented by autopsy, histopathology, surgery, and radiology, including the heart, blood vessels, kidney, spine, eye, skin, and gastrointestinal system. These studies extend the significance of gout beyond the rheumatologist and emphasize the need for physicians to follow the American College of Rheumatology guidelines to treat subjects with gout to a goal of achieving serum urate <6 mg/dl. Given the growing body of literature on extraarticular urate deposition, further studies and clinical trials are needed to determine the clinical consequences of systemic urate deposition, including if reducing cardiac and vascular urate deposits may provide a survival benefit for this at-risk population.

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“…However, they can develop without the concomitant arthritis . Iglesia et al used the term “gouty nodulosis” to describe the subcutaneous deposits of MSU without gouty arthritis as initial manifestation …”

Section: Discussionmentioning

confidence: 99%

Gouty tophi presenting as multinodular lateral inguinal swelling: A case report

Goel

Khanna

Jain

et al. 2018

Diagnostic Cytopathology

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Fine-needle aspiration cytology (FNAC) is an important diagnostic tool which is replacing biopsy for the diagnosis of subcutaneous nodules. We present a case of 75 years old female with right sided multinodular lateral inguinal swelling since 2 years, without any clinical features of arthritis. FNAC of the lesion revealed negatively birefringent, long needle shaped monosodium urate crystals in the background of amorphous granular debris. Further investigations revealed high serum uric acid levels (9.36 mg/dL) and a confirmed diagnosis of gouty tophus was made. It is important that pathologist should be aware of the cytological features of gouty tophus, particularly in the case with unusual presentation. Gouty nodulosis has never been reported in literature at this site and we are first to report gouty tophus at this unique site.

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Gout nodulosis: Widespread subcutaneous deposits without gout

Abstract: Subcutaneous tophaceous deposits of monosodium

Cited by 29 publications

References 31 publications

Clinical features of gout

Clinical features of gout

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Gouty tophi presenting as multinodular lateral inguinal swelling: A case report

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