Case report and disease review:Tophaceous gouty arthropathy
Gout is a common inflammatory and metabolic disorder of the joints and probably other
organs, especially the kidneys. It has a definitive genetic and environmental background,
making it mainly a disease of middle-aged and elderly males, infrequently inflicting
postmenopausal and elderly women who usually have arterial hypertension, renal
impairment, and usually on diuretics.
Excessive tissue urate turnover and persistent hyperuricemia is the hallmark of the
disease. A typical algorithm is characterized by acute attack of the monoarticular joint,
the metatarsophalangeal joint of the big toe often is involved (podagra), but tarsal joints,
ankles, and knees might also be affected.
Chronic asymmetric polyarticular arthritis that might be confused with classical Rheumatoid
Arthritis might be encountered in some patients and in recurrent and relapsing diseases. In
this setting, many organs and tissues are affected by the deposition of monosodium urate
(MSU) crystals other than synovium, bursae, tendons, and periarticular tissues. The risk of
involvement of renal interstitium or uric acid nephrolithiasis has a particular interest in the
course of the disease.
By the inflammation and collection of MSU crystals in form of tophi that might involve
many tissues and occasionally the pinna of the ears, this kind of tophaceous gout is rarely
observed nowadays, especially in our community (Middle East region). The patient who is
presented here has exhibited acute attack on the top of chronic tophaceous gouty arthritis.
The recent epidemiologic reports revealed that gout has given different results. This wide
variation is attributed to the population studied and methods employed, but overall, for
the prevalence of <1% to 6.8% and an incidence of 0.58-2.89 per 1,000 person per year.
The most noticeable risks for gout are obesity and associated metabolic syndrome (insulin
resistance, hypertension, dyslipidaemia), dietary factors, high fructose-containing diet, high
purine diet (red meat, internal organ’s meat ,seafood) high consumption of alcohol, and
exclusively beer ( as in our patient’s case ), a wide variety of disorders that are characterized
by high urate turnover like myeloproliferative disorders, neoplasms, psoriasis, haemolytic
anaemias, medications , to under-secretion of urate like renal insufficiency