Poster Highlight: A Patient With a 40-Year History of Tophaceous Gout

A poster at the recent APMA National in Washington DC presented a unique case of a 62-year-old male with a nearly 40-year history of tophaceous gout.¹ His medical history was complex and included the aforementioned gout, atrial fibrillation, heart failure, hypertension, hyperlipidemia, myocardial infarction, and uric acid renal stones. His past surgical history included amputation of the right hallux due to gouty tophi and and chronic ulceration. Upon presentation to the authors’ practice, he had a concern of severe tophaceous gout to the left first MTPJ and midfoot. His past medications for the gout included febuxostat, colchicine, and prednisone. He did not tolerate allopurinol. He had recently begun treatment with an interleukin-1 receptor antagonist.¹

To mitigate his high risk for ulceration on the left side, the patient underwent excision of tophi and curettage at the first MTPJ and dorsal midfoot, including intratendinous tophi along the extensor hallucis longus. Pathology analysis revealed negatively birefringent needle-shaped crystals. By 2 months postoperatively, the patient was weight-bearing in his normal shoe gear and had healed at all incision sites. This surgical effort was part of a multidisciplinary approach undertaken by podiatry, rheumatology, and nephrology.¹   

The authors stress the life-changing nature of this condition, with impact from significant arthritic changes, recurring flares, pain, and risk for ulceration. Additionally, the patients can experience significant mental health distress and issues from nephrolithiasis. As exemplified from this case, they contend that a multidisciplinary approach to treatment, possibly including behavioral health, could have a positive impact on outcomes.

Reference
1.        Azizi S, Park D, Mele S. Systemic manifestations of chronic tophaceous gout in a patient with uric acid nephropathy. Poster presented at the APMA National. August 2024. Washington, DC.