Tophaceous gout: an unusual cause of multiple fractures

Nguyen, Cristina; Ea, Hang‐Korng; Palazzo, Élisabeth; Lioté, Frédéric

doi:10.3109/03009740903061428

Cited by 40 publications

(22 citation statements)

References 10 publications

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“…Consistent with these reports fractures have been noted at the site of tophi in patients with tophaceous gout [29]. It is unclear whether hyperuricemia may affect bone health via non-crystal mechanisms in the absence of gout.…”

Section: 0 Discussionsupporting

confidence: 53%

Serum urate levels and the risk of hip fractures: data from the Cardiovascular Health Study

Mehta¹,

Bůžková²,

Sarnak³

et al. 2015

Metabolism

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Purpose Uric acid inhibits vitamin D activation experimentally and higher serum urate levels are associated with higher parathyroid hormone levels in humans suggesting a link between uric acid and bone health. We hypothesized that hyperuricemia may increase the risk of fractures in older adults. Methods 1963 men and 2729 women ≥ 65 years of age who participated in the Cardiovascular Health Study and had baseline serum urate levels were included in the study. The primary outcome was incident hip fracture, assessed prospectively through June, 2008 by inpatient and outpatient records. The analysis was stratified by sex apriori. Results There was a U- shaped relationship between serum urate levels and hip fractures in men. Men in the lowest and the highest urate quartiles (<4.88 and ≥6.88 mg/dL respectively) had a significantly higher rate of fractures in unadjusted analysis. However, upon multivariate adjustment, only the HR for hip fracture in highest quartile versus the reference remained significant (HR 1.9; 95% C.I. 1.1, 3.1; p value 0.02). High serum urate levels were not associated with hip fractures in women. Conclusion In this large prospective cohort of community-dwelling older adults, increased serum urate levels were associated with an increased risk of hip fractures in men. Further studies are needed to confirm these findings and to understand the mechanisms that underlie them.

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Section: 0 Discussionsupporting

confidence: 53%

Serum urate levels and the risk of hip fractures: data from the Cardiovascular Health Study

Mehta¹,

Bůžková²,

Sarnak³

et al. 2015

Metabolism

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“…The feet were the most common site affected in the both decades while the spine, absent in 1990-2000, became the second localization in the recent years. Physicians have to keep in mind this possible localization of tophi because it is an important cause of disabilities (e.g., relating to fractures) in elderly patients [16] and often represented an isolated localization (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

Tophaceous gout in the elderly: a clinical case review

et al. 2012

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Gout is the most common cause of arthritis in the elderly. Its incidence among older people has risen worldwide due to an increase in risk factors such as renal diseases, metabolic syndrome, and a diet rich in purines. In older age, tophaceous gout may affect different joints from its classical presentation, due to other concomitant musculoskeletal diseases, but specific data on its epidemiology and clinical aspects in the elderly are limited to a few case reports. The present review focuses on the distinctive aspects of tophaceous gout in the elderly, revisiting all our clinical cases seen from 1990 to December 2011. Our findings indicate that: tophaceous gout can affect several joints in the elderly, including some unusual sites; its incidence is similar in both genders in the elderly even if the latency period between its initial diagnosis and the onset of tophi is higher in men; and vertebral localizations are rising and often solitary. The components of metabolic syndrome are the most common medical conditions associated with tophaceous gout. In conclusion, tophaceous gout in the elderly may be a growing medical problem and cause of disability in years, partly because of the new sites involved.

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“…A definitive diagnosis of unusually located gouty tophi requires a histopathological examination. Gouty tophi are characterized by foreign body granulomas comprising mono-and multinucleated macrophages surrounding the deposits of MSU crystals [7] . The presence of calcium pyrophosphate crystals as a result of pseudogout must be considered, and polarized light microscopy helps differentiate the pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…The first episode of acute gouty arthritis generally begins with joint pain and swelling. It may also present with nonspecific complaints caused by gouty tophi in unusual sites of the body such as the spine, bone, and middle ear [4][5][6][7][8][9] . Such involvement can be disabling and can impair the quality of life.…”

Section: Introductionmentioning

confidence: 99%

An Unusual Presentation of Gout: Tophi in the Middle Ear

Mutlu

Dündar²,

İşeri³

et al. 2016

Int Adv Otol

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Gout is a common metabolic disease and is characterized by episodic acute and chronic arthritis caused by the deposition of monosodium urate (MSU) crystals in joints and connective tissues. The most commonly involved joint is the first metatarsophalangeal joint. It may also present with nonspecific complaints caused by gouty tophi in unusual sites of the body such as the spine, bone, and middle ear. Such involvements can be disabling and impair the quality of life. In this report, we describe the case of a patient who had complaints of hearing loss and otorrhea. A 34 year-old male patient presented with complaints of recurrent otorrhea and hearing loss for several months. He had no history of joint pain or constitutional symptoms at the time of admission. An otoscopic examination of the left ear revealed subtotal tympanic membrane perforation, and white middle ear plaques were detected. The patient underwent intact canal mastoidectomy under general anesthesia, and middle ear sclerosis was determined as Wieling Kerr classification type 2. Postoperative histopathologic examination of the specimen revealed amorphous eosinophilic deposits within fibrous stroma and tophi containing negatively birefringent MSU crystals by polarized light. After the histopathologic diagnosis of gout, the patient was assessed for peripheral joint involvement. He had no radiographic abnormalities. The patient was administered a serum urate-lowering therapy, given a low purine diet, and followed with the diagnosis of tophaceous gout. Unusual localizations of gouty tophi have been reported in the literature. Gouty tophi should also be considered in the differential diagnosis of middle ear masses alongside common pathologies.

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Tophaceous gout: an unusual cause of multiple fractures

Cited by 40 publications

References 10 publications

Serum urate levels and the risk of hip fractures: data from the Cardiovascular Health Study

Serum urate levels and the risk of hip fractures: data from the Cardiovascular Health Study

Tophaceous gout in the elderly: a clinical case review

An Unusual Presentation of Gout: Tophi in the Middle Ear

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