Application and effect evaluation of multidisciplinary collaboration in patients with tophi during perioperative period / 中华风湿病学杂志

Objective:To explore the application and effect of multidisciplinary collaboration in patients with tophi during perioperative period.Methods:Forty-five patients undergoing tophaceous gout surgery in our hospital from May to October 2020 were selected as the control group and treated with routine treatment.From November 2020 to April 2021, 41 patients undergoing tophaceous gout surgery in our hospital who were treated with multidisciplinary collaboration management mode were included as the intervention group. Postoperative pain, blood uric acid level, hospitalization expenses, hospitalization days and patient satisfaction were compared between the two groups.Results:After implementing the multidisciplinary integration man-agement mode, the pain score of the patients at 4 hours, 1 day and 3 days after operation was lower than that of the control group [(3.6±1.0) vs (4.1±1.0), t=2.33, P=0.022; (2.5±0.8) vs (3.0±0.6), t=3.85, P<0.001; (1.8±0.5) vs (2.2±0.7), t=3.52, P<0.001], the serum uric acid level was significantly lower than that of the control group at 1 month and 3 months after operation [(355±58) vs (3928±39), t=3.50, P=0.001; (316±48) vs (366±47), t=4.84, P<0.001], the hospitalization days and hospitalization expenses were significantly decreased [(8.90±2.48) d vs (10.62±3.96) d, t=2.44, P=0.017; (1.00±0.13) ten thousand yuan vs (1.11±0.17) ten thousand yuan, t=3.34, P=0.001], and the patient satisfaction was markedly improved (97.6% vs 82.2%, χ2=3.87, P=0.049). Conclusion:The multi-disciplinary collaboration mode in patients with tophi during perioperative period can effectively reduce the postoperative pain, improve the quality of care, promote reha-bilitation, improve the outcome, and reduce the economic burden of patients, which is worthy of popularization and being applied in clinic.

Gota tofácea crónica en un adulto / Chronic tophaceous gout in an adult

Se presenta el caso clínico de un paciente de 57 años de edad, mestizo, con antecedentes de artritis reumatoidea y gota, quien acude a la consulta especializada de Dermatología del Hospital Clinicoquirúrgico Docente Celia Sánchez Manduley de Manzanillo, provincia de Granma, por presentar lesiones nodulares dolorosas diseminadas. Se realizaron estudios complementarios y biopsia de piel, cuyos resultados permitieron diagnosticar una gota tofácea crónica. El paciente llevaba tratamiento medicamentoso con prednisona, colchicina y metrotexate, pero luego de discutir el caso con los especialistas en medicina interna y reumatología se decidió sustituir la colchicina por el alopurinol.

The case report of a 57 year-old mestizo patient, is presented with a history of rheumatoid arthritis and gout who visited the specialized Dermatology department of Celia Sánchez Manduley Teaching Clinical-Surgical Hospital in Manzanillo, Granma province, for presenting disseminated painful nodular lesions. Complementary studies and skin biopsy were carried out which results allowed to diagnose a chronic . The patient was under drugs treatment with prednisona, colchicina and metrotexate, but after discussing the case with the specialists in internal medicine and rheumatology it was decided to sustitute colchicina by alopurinol.

Clinics in diagnostic imaging (200). Intra-articular chronic tophaceous gout of the knee

A 39-year-old man presented with acute left knee pain and swelling. There was limitation of movement of the knee joint. His past medical history was significant for gout. Computed radiography showed bony erosions that were not typical of chronic tophaceous gout. Magnetic resonance (MR) imaging showed focal deposits within the knee joint, which demonstrated isointense signal to muscle on T1-weighted sequence and intermediate signal on proton density (PD) and PD fat-saturated sequences. There was extensive, similar signal abnormality in the cruciate ligaments, popliteus tendon and lateral meniscus. These findings were in keeping with an intra-articular manifestation of chronic tophaceous gout. The clinical presentation and imaging features are herein discussed, with an emphasis on MR imaging.

Surgical Treatment of Chronic Tophaceous Gout in the 1st Metatarso-Phalangeal Joint / 대한족부족관절학회지

PURPOSE: Chronic tophaceous gout is a painful and disabling inflammatory disease. Surgical treatment for chronic tophaceous gout is very difficult with many complications. This study evaluated the efficacy of shortening scarf osteotomy on the treatment of chronic tophaceous gout in the 1st metatarso-phalangeal (MTP) joint. MATERIALS AND METHODS: From January 2006 to December 2015, 14 patients (19 cases) who underwent axial shortening scarf osteotomy for chronic tophaceous gout were reviewed. All patients were male. The average age at the time of surgery was 59.6 years (42~66 years). The minimum follow-up was 24 months. Total removal of the tophi mass with the adhered medial capsule of the 1st MTP joint was attempted. Axial shortening scarf osteotomy was done on the 1st metatarsal shaft. The visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was assessed preoperatively and postoperatively. The range of motion (ROM) of the 1st MTP joint was also compared pre- and postoperatively. RESULTS: The average size of the extracted tophaceous mass was 32 mm. The mean amount of the length of metatarsal shortening was 4.9 mm. The mean ROM of the 1st MTP joint was improved from 30.4° to 62.3°. The mean AOFAS forefoot score improved from 51.4 to 86.6 points. The mean VAS for pain improved from 4.6 to 0.3 points. CONCLUSION: The axial shortening scarf osteotomy used on chronic tophaceous gout could reconstruct the 1st MTP joint with an improved ROM and was free of pain. Axial shortening scarf osteotomy is suggested as a useful and effective method for the treatment of chronic tophaceous gout.

Management of Complicated Gout / 대한내과학회지

Chronic tophaceous gout results from long-term uncontrolled hyperuricemia with accumulation of urate crystals in joints, soft tissues, tendon sheaths and bony prominence. Urate-lowering agents should be administered to reduce serum uric acid level to less than 5 mg/dL for tophi reabsorption. Surgical indications include restoration of joint and tendon dysfunction, nerve decompression, debridement of septic joints, pain relief and cosmesis. Gout patients are at greater risk of forming uric acid stones. The renal tubular abnormality related to gout and metabolic syndrome leads to excretion of acidic urine, which favors formation of the relatively insoluble uric acid than more soluble urate. The corner stone of treatment of uric acid stone is urine alkalinization. Lowering serum uric acid with allopurinol and increasing urine volume are also important. Allopurinol is poorly tolerated and ineffective or contraindicated in some patients. Benzbromarone, a uricosuric agent is a useful alternative but possible hepatotoxicity should be monitored. Desensitization of allopurinol can be attempted to patients with mild cutaneous hypersensitivity. For gout patients with chronic renal failure, allopurinol dose need to be adjusted and nonsteroidal anti-inflammatory drugs and colchicine may be contraindicated.

Gota tofácea crónica: presentación de caso, servicio de medicina interna / Chronic Tophaceous Gout: A case presentation, Internal Medicine Service

El siguiente trabajo es la presentación de un caso ingresado en el servicio de Medicina Interna del Hospital Provincial Abel Santamaría Cuadrado, provincia Pinar del Río, en septiembre del 2007, con el diagnóstico de Gota Tofácea crónica. Este paciente presentaba una artritis invalidante y la presencia de tofos con grandes dimensiones que han provocado la anquilosis articular y deformaciones significativas. Considerando que es de gran interés semiológico para estudiantes de pre y postgrado, así como personal médico en general, pues en la actualidad es difícil encontrar pacientes con las manifestaciones encontradas al examen físico de este caso, debido a la prontitud del diagnóstico, la sistematicidad del tratamiento que se realiza en estos momentos.

The present study is a case presentation admitted at Internal Medicine Service in Abel Santamaría Cuadrado Provincial Hospital in September 2007 with a diagnosis of chronic tophaceous gout. This patient presented an invalid arthritis and the presence of tophos with large dimensions provoking the articular ankylosis and significant malformations being interesting semiologically to pregraduate and postgraduate students as well as the medical staff in general because it is hard to find out patients with manifestations found in the physical examination at present due to the quickness of diagnosis and systematicity of the treatment.

Tophaceous Gout Involving the Bipartitle Patella: A Case Report

Gout is a metabolic disorder manifested by hyperuricemia due to genetic or acquired diseases. The pathognomic lesion is the tophus which fine crystals of monosodium urate are deposited in articular carti- lage, synovia, tendon sheaths and other periarticular structures, epiphyseal bone, subcutaneous layers of the skin, and interstitial areas of the kidney. Frequent sites of tophaceous deposit are the external ear and subcutaneous deposits in the finger tips, palms and soles. Tophaceous gout involving the space of bipartite patella is very unusual and has not been reported before in Korea. So, we report a case of 38 year old male patient who presented with tophaceous gout involving the space of bipartite patella with review of literatures.