Ulcerated tophaceous gout

Patel, Girish Khandubhai; Davies, Wendy; Price, Patricia Elaine; Harding, Keith

doi:10.1111/j.1742-481x.2010.00700.x

Cited by 21 publications

(21 citation statements)

References 24 publications

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“…Although other factors, such as tophus duration and location, were associated with the presence of ulceration in univariate analysis, these factors were not independently associated with ulceration when age, tophus size and lack of protective sensation were included in the regression models. Previous studies have mainly been case reports describing the operative approach to ulceration over tophi and wound healing . To the authors' knowledge, the present study is the first to report risk factors associated with ulceration over tophi in patients with gout.…”

Section: Discussionmentioning

confidence: 71%

Risk factors for ulceration over tophi in patients with gout

Cai

Zhang

et al. 2016

International Wound Journal

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Ulceration over tophi in patients with gout usually causes a number of clinical problems. The aim of this study was to investigate the risk factors for ulceration of tophi in patients with gout. Patients with gout who had tophi with or without ulceration were prospectively recruited and underwent a comprehensive clinical assessment. Clinical factors independently associated with the presence of ulceration were analysed using logistic regression models. Of the 113 participants, 18 (13·7%) had clinically apparent ulceration over tophi. In univariate analysis, ulceration over tophi correlated with age, tophus duration, size, location and lack of protective sensation. In logistic regression analysis, age, tophus size and lack of protective sensation were associated with ulceration over tophi. These findings indicate that old age, large tophus size and lack of protective sensation were independent risk factors for ulceration over tophi.

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Section: Discussionmentioning

confidence: 71%

Risk factors for ulceration over tophi in patients with gout

Cai

Zhang

et al. 2016

International Wound Journal

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“…Multiple, small areas of ulceration appear to be typical of gouty arthritis, particularly chronic tophaceous polyarticular gout, although larger single areas of ulceration have also been observed. Calcified tophaceous deposits, which have been reported to be associated with connective tissue destruction, can act like a foreign body traumatising the wound bed, causing inflammation and increasing exudate levels . Lui states that a large tophus can impede healing by causing localised ischaemia and preventing granulation tissue from forming.…”

Section: Discussionmentioning

confidence: 99%

“…Breakdown of tissue overlying the tophus may lead to persistent discharge and chronic ulceration. On the feet, particularly overlying areas of joint deformity and on weight‐bearing areas, these ulcerated tophaceous gouty lesions can become encapsulated in hyperkeratosis, increasing the risk of further tissue breakdown and delayed healing . Data from the UK provide some insight into the presentation patterns of foot ulceration in rheumatoid arthritis (RA) and the impact on health‐related quality of life (HRQL) , but the clinical characteristics of wounds in affected gout patients are poorly defined .…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of foot ulceration in people with chronic gout

Rome

Erikson

Otene

et al. 2014

International Wound Journal

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Gout is the most common form of inflammatory arthritis and it has an affliction to the foot. Foot involvement in gout has been linked to foot pain, impairment and disability. There has been limited research on the effect of ulceration on foot pain, impairment, disability and health-related quality of life in patients already living with gout. The aim of the study was to describe the wound characteristics and the effect on foot pain, disability and health-related quality of life in patients with foot ulceration associated with gout. Participants were recruited from rheumatology clinics in Auckland, New Zealand. All the current foot ulceration sites and wound characteristics were recorded using the TIME wound assessment tool. The outcome measures included general pain, patient global assessment scale, foot pain, disability and impairment. Participants completed the Cardiff Wound Impact Schedule to assess the effect of ulcers on health-related quality of life. Sensory loss, vibrational thresholds and ankle brachial pressure index were collated to assess for lower limb arterial disease. Six participants were predominantly older men with a long duration of gout, high rates of obesity and co-morbidities such as hypertension, hyperlipidaemia, diabetes and cardiovascular disease. The mean (SD) duration of the foot ulcers was 4 (2) months. The majority of foot ulcers observed were 0·5 cm(2) or smaller superficial thickness with surrounding callus. Partial thickness and full-thickness ulcers were also observed. Two patients presented with ulcers on multiple sites. There was only one case of infection. Gouty tophi were evident in most of the wounds. The dorsal aspect of the third toe was found to ulcerate in most cases. Moderate scores of foot pain, disability, impairment and health-related quality of life were observed. Most participants wore shoes deemed as poor. Foot ulceration in gout is chronic and multiple ulcers can occur with the potential of leading to delayed wound healing, infection and a reduced quality of life. Poor footwear may contribute to the development and delayed healing of ulceration in people with gout.

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“…Tophi are typically found on the helix of the ears, on fingers, toes, wrists and knees, on the olecranon bursae, on the Achilles tendons and also rarely on the sclerae, subconjuctivally, [4] and on the cardiac valves [5]. They can cause pain and dysfunction and are rarely associated with ulcerations [6], bone fractures [7], tendon and ligament rupture [8], carpal tunnel [9] and other nerve compression syndromes [10]. Differential diagnosis for subcutaneous or articular nodules includes septic arthritis, synovial cysts, nodal osteoarthritis, rheumatoid arthritis, sarcoidosis, lymphoma or neoplasms [11].…”

Section: Discussionmentioning

confidence: 99%

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

et al. 2011

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IntroductionGout is a common inflammatory arthritis caused by articular precipitation of monosodium urate crystals. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints, such as wrists, elbows, knees and ankles.Case presentationWe report the case of a 75-year-old Caucasian man with tophaceous multiarticular gout, soft-tissue involvement and ulcerated tophi on the first metatarsophalangeal joint of the left foot, on the first interphalangeal joint of the right foot and on the left thumb.ConclusionUlcers due to tophaceous gout are currently uncommon considering the positive effect of pharmaceutical treatment in controlling hyperuricemia. Surgical treatment is seldom required for gout and is usually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction.

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Ulcerated tophaceous gout

Cited by 21 publications

References 24 publications

Risk factors for ulceration over tophi in patients with gout

Risk factors for ulceration over tophi in patients with gout

Clinical characteristics of foot ulceration in people with chronic gout

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

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