A Simple Guide to Gouty Arthritis (With Tophi), Diagnosis, Treatment and Related Conditions

This book describes Gouty Arthritis with Tophi, Diagnosis and Treatment and Related Diseases

Suddenly I had a patient who presented with gouty arthritis with tophi formation in the right big toe.

Normally patients with gout will present with painful red and swollen joints that are acutely painful and I would either treat them with medicines, injections of steroids and aspiration of joint effusion (especially for the knee joint which could be affected and badly swollen).

This patient presented with a painful and swollen right big toe which was tender to touch and white area in the center which I mistook to be due to pus formation.

I decided to incise it under local anesthesia to drain out the pus formation.

To my surprise the white patch beneath the skin was due to deposits of uric acid crystals or gout tophi which had to be removed carefully because they can reach the bones of the joint.

I did daily cleaning of the wound to prevent infection and prescribed allopurinol, probencid (to reduce the urate concentration in the blood) and antibiotics (to stop any infections of the wound).

There was a slow healing period of 6 weeks before the wound finally resolved.

Unlike an acute attack of gout, gouty arthritis of the joint with tophi indicates exposure to prolonged higher uric acid blood concentration and requires a longer period of treatment of diet restrictions, uric acid reduction medicines such as allopurinol. febuxostat, probenecid and colchicine and careful surgical treatment or aspiration of joint effusion.

Hyperuricemia (Gout)

I had a patient who would limp into my clinic every time after a night out drinking alcohol.

I would give him an injection into the most painful joint and a uricosuric drug (to pass out the uric acid from the body through the urine) and pain killer.

After the injection he was able to walk out of the clinic without limping

He would be well until the next episode of gouty arthritis.

Some other patient a Malay middle aged gentleman will have the same problem after taking peanuts while watching football matches on television.

Recently I have a woman patient whose family has gout who had an acute attack of gout which occurs after the removal of her womb and ovaries for enlarged fibroid.

She had never believed the brother’s story of how painful the big toe can become until she experienced it herself.

She just has taken her usual amount of soya bean curds and other soya bean foods which have never given her problem before.

Probably her female hormones may have protected her earlier from the gout.

The second time she had the gout attack was in her knee which became larger than usual.

I had to give her an injection of steroid in her knee before it finally recovered.

Another young patient, who is vegetarian, has a severe episode of diarrhea and vomiting also developed severe pain in his right big toe

It was due to the dehydration which caused the uric acid to go up.

In addition he was also taking high protein bars.

He improved after taking medicines and drinking lots of water.

Gouty arthritis, also known as gout, is a type of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints.

It is featured by sudden and severe attacks of pain, redness, swelling, and tenderness in the affected joints, most commonly in the big toe.

Gout tophi are lumps or nodules that develop as a result of the accumulation of urate crystals

Treatment for gouty arthritis aims to manage acute attacks, prevent future attacks, and reduce the risk of complications

TABLE OF CONTENT
Introduction

Chapter 1 Gouty Arthritis

Chapter 2 Cause

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7

Chapter 8

Epilogue
TABLE OF CONTENT
Introduction

Chapter 1 Gouty Arthritis with tophi

Chapter 2 Cause

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7 Hyperuricemia

Chapter 8 Pseudogout

Epilogue