The Pathognomic Radiologic Features of Gout in the Fingers and Review of the Literature, Including the Latest Drug Therapy

Mehdi Hossaini, Eric Tetteroo, Frank M.A. Slaats, Annechien Beumer

Department of Orthopaedic Surgery, Amphia Hospital Breda, The Netherlands.
Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Department of Radiology, Amphia Hospital Breda, Breda, The Netherlands.
Department of Rheumatology, Amphia Hospital Breda, Breda, The Netherlands.

DOI: 10.4236/ojrad.2013.33017                

Abstract

Gout is one of the most common inflammatory arthritides that predominantly affects the first metatarsophalangeal joint. The underlying inflammatory process is elicited by the deposition of monosodium urate (MSU) crystals in the affected joint that are termed tophi and which may in the course of chronic gout progress into subcutaneous depositions of tophi. In this case report, we present a patient (PID: 6925981) who was seen in our outpatient department with a first episode of tophaceous gout in the finger, an infrequently seen condition that mostly affects older men with long-term gout. We discuss the case in view of the current literature on diagnosis and treatment of tophaceous gout.

Keywords

Gout; Tophi; Interphalangeal Joint; Finger; Monosodium Urate; Arthritis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. Nuki and P. A. Simkin, “A Concise History of Gout and Hyperuricemia and Their Treatment,” Arthritis Re search & Therapy, Vol. 8, Suppl. 1, 2006, pp. S1-S5.
[2]	L. Punzi, A. Scanu, R. Ramonda and F. Oliviero, “Gout as Autoinflammatory Disease: New Mechanisms for More Appropriated Treatment Targets,” Autoimmunity Reviews, Vol. 12, No. 1, 2012, pp. 66-71. doi:10.1016/j.autrev.2012.07.024
[3]	W. Zhang, M. Doherty, E. Pascual, T. Bardin, V. Barskova, P. Conaghan, J. Gerster, J. Jacobs, B. Leeb, F. Liote, G. McCarthy, P. Netter, G. Nuki, F. Perez-Ruiz, A. Pignone, J. Pimentao, L. Punzi, E. Roddy, T. Uhlig and I. Zimmermann-Gorska, “EULAR Evidence Based Rec ommendations for Gout. Part I: Diagnosis. Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT),” An nals of the Rheumatic Diseases, Vol. 65, No. 10, 2006, pp. 1301-1311. doi:10.1136/ard.2006.055251
[4]	E. Roddy, W. Zhang and M. Doherty, “Are Joints Affected by Gout Also Affected by Osteoarthritis?” Annals of the Rheumatic Diseases, Vol. 66, No. 10, 2007, pp. 1374-1377. doi:10.1136/ard.2006.063768
[5]	P. Richette and T. Bardin, “Gout,” Lancet, Vol. 375, No. 9711, 2010, pp. 318-328. doi:10.1016/S0140-6736(09)60883-7
[6]	H. K. Choi and E. S. Ford, “Prevalence of the Metabolic Syndrome in Individuals with Hyperuricemia,” The American Journal of Medicine, Vol. 120, No. 5, 2007, pp. 442-447. doi:10.1016/j.amjmed.2006.06.040
[7]	M. Marangella, “Uric Acid Elimination in the Urine. Pathophysiological Implications,” Contributions to Ne phrology, Vol. 147, No. 2005, pp. 132-148.
[8]	K. L. Wallace, A. A. Riedel, N. Joseph-Ridge and R. Wortmann, “Increasing Prevalence of Gout and Hyperuricemia over 10 Years among Older Adults in a Managed Care Population,” The Journal of Rheumatology, Vol. 31, No. 8, 2004, pp. 1582-1587.
[9]	P. C. Robinson, T. R. Merriman, P. Herbison and J. Highton, “Hospital Admissions Associated with Gout and Their Comorbidities in New Zealand and England 1999 2009,” Rheumatology, Vol. 52, No. 1, 2013, pp. 118-126. doi:10.1093/rheumatology/kes253
[10]	G. Trifiro, P. Morabito, L. Cavagna, C. Ferrajolo, S. Pe cchioli, M. Simonetti, E. Bianchini, G. Medea, C. Cricelli, A. P. Caputi and G. Mazzaglia, “Epidemiology of Gout and Hyperuricaemia in Italy during the Years 2005-2009: A Nationwide Population-Based Study,” Annals of the Rheumatic Diseases, Vol. 72, No. 5, 2013, pp. 694-700. doi:10.1136/annrheumdis-2011-201254
[11]	H. K. Choi, K. Atkinson, E. W. Karlson, W. Willett and G. Curhan, “Alcohol Intake and Risk of Incident Gout in Men: A Prospective Study,” Lancet, Vol. 363, No. 9417, 2004, pp. 1277-1281. doi:10.1016/S0140-6736(04)16000-5
[12]	H. K. Choi, K. Atkinson, E. W. Karlson, W. Willett and G. Curhan, “Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men,” The New England Journal of Medicine, Vol. 350, No. 11, 2004, pp. 1093-1103. doi:10.1056/NEJMoa035700
[13]	H. K. Choi and G. Curhan, “Soft Drinks, Fructose Consumption, and the Risk of Gout in Men: Prospective Cohort Study,” British Medical Journal, Vol. 336, No. 7639, 2008, pp. 309-312. doi:10.1136/bmj.39449.819271.BE
[14]	T. Gibson, “Clinical Features of Gout,” In: M. Hochberg, Ed., Rheumatology, Mosby, Edinburg, 2003, pp. 1919 1928.
[15]	R. Wortmann, “Gout and Hyperuricaemia,” In: G. Fire stein, Ed., Kelley’s Textbook of Rheumatology, Saunders Elseviers, Philadelphia, 2008, pp. 1481-1524.
[16]	A. Alexandroff, N. Kirkham and N. Nayak, “A Painless, Swollen Finger (for 20 Years),” Lancet, Vol. 371, No. 9618, 2008, p. 1114. doi:10.1016/S0140-6736(08)60487-0
[17]	J. M. Geiderman, “An Elderly Woman with a Warm, Painful Finger,” The Western Journal of Medicine, Vol. 172, No. 1, 2000, pp. 51-52. doi:10.1136/ewjm.172.1.51
[18]	F. Bolzetta, N. Veronese, E. Manzato and G. Sergi, “To phaceous Gout in the Elderly: A Clinical Case Review,” Clinical Rheumatology, Vol. 31, No. 7, 2012, pp. 1127 1132. doi:10.1007/s10067-012-1956-x
[19]	A. M. Denman, L. Szur and B. M. Ansell, “Joint Com plaints in Polycythaemia Vera,” Annals of the rheumatic diseases, Vol. 23, No. 1964, pp. 139-144.
[20]	M. Denman, L. Szur, and B. M. Ansell, “Hyperuricaemia in Polycythaemia Vera,” Annals of the Rheumatic Dis eases, Vol. 25, No. 4, 1966, pp. 340-344.
[21]	L. R. Wasserman, “Polycythemia Vera: Its Course and Treatment; Relation to Myeloid Metaplasia and Leuke mia,” Bulletin of the New York Academy of Medicine, Vol. 30, No. 5, 1954, pp. 343-375.
[22]	B. A. Briesacher, S. E. Andrade, H. Fouayzi and K. A. Chan, “Comparison of Drug Adherence Rates among Pa tients with Seven Different Medical Conditions,” Phar macotherapy, Vol. 28, No. 4, 2008, pp. 437-443. doi:10.1592/phco.28.4.437
[23]	A. T. Eggebeen, “Gout: An Update,” American Family Physician, Vol. 76, No. 6, 2007, pp. 801-808.
[24]	K. M. Jordan, “Up-to-Date Management of Gout,” Current Opinion in Rheumatology, Vol. 24, No. 2, 2012, pp. 145-151.
[25]	F. Perez-Ruiz, L. Martinez-Indart, L. Carmona, A. M. Herrero-Beites, J. I. Pijoan and E. Krishnan, “Tophaceous Gout and High Level of Hyperuricaemia are Both Asso ciated with Increased Risk of Mortality in Patients with Gout,” Annals of the Rheumatic Diseases, 2013, in Press.
[26]	E. Suresh and P. Das, “Recent Advances in Management of Gout,” Monthly Journal of the Association of Physi cians, Vol. 105, No. 5, 2012, pp. 407-417.
[27]	R. H. Gelberman, D. H. Doty and M. L. Hamer, “Topha ceous Gout Involving the Proximal Interphalangeal Joint,” Clinical Orthopaedics and Related Research, Vol. 147, 1980, pp. 225-227.
[28]	A. Brower and D. Flemming, “Gout”, In: Arthritis: In Black and White, WB Saunders, Philadelphia, 1997, pp. 325-341.
[29]	J. A. Jacobson, G. Girish, Y. Jiang and B. J. Sabb, “Ra diographic Evaluation of Arthritis: Degenerative Joint Disease and Variations,” Radiology, Vol. 248, No. 3, 2008, pp. 737-747. doi:10.1148/radiol.2483062112
[30]	P. V. Chowalloor and H. I. Keen, “A Systematic Review of Ultrasonography in Gout and Asymptomatic Hyperuricaemia,” Annals of the Rheumatic Diseases, Vol. 72, No. 5, 2013, pp. 638-645. doi:10.1136/annrheumdis-2012-202301
[31]	E. De Miguel, J. G. Puig, C. Castillo, D. Peiteado, R. J. Torres and E. Martin-Mola, “Diagnosis of Gout in Pa tients with Asymptomatic Hyperuricaemia: A Pilot Ul trasound Study,” Annals of the Rheumatic Diseases, Vol. 71, No. 1, 2012, pp. 157-158. doi:10.1136/ard.2011.154997
[32]	H. K. Choi, L. C. Burns, K. Shojania, N. Koenig, G. Reid, M. Abufayyah, G. Law, A. S. Kydd, H. Ouellette and S. Nicolaou, “Dual Energy CT in Gout: A Prospective Validation Study,” Annals of the Rheumatic Diseases, Vol. 71, No. 9, 2012, pp. 1466-1471. doi:10.1136/annrheumdis-2011-200976