Magnetic resonance spectroscopy in the management of tophaceous gout: A case report
DOI:
https://doi.org/10.22122/cdj.v3i1.144Keywords:
Gout, Urate, Magnetic Resonance Spectroscopy, Tophaceous GoutAbstract
Development of chronic tophaceous arthritis with marked joint impairment may follow repeated acute attacks. We present a 60 year-old man with huge urate deposits and severe gouty arthropathy with underlying hypothyroidism. During the past years, he had undergone several surgeries with different degrees of amputation to remove the tophus. Magnetic resonance spectroscopy (MRS) of foot finger revealed high peak of lactate, suggesting that high lactate levels is linked with chronic gout and frequent attacks. The patient was treated with levothyroxine along with gout medication, and his thyroid-stimulating hormone (TSH) and urate levels were soon normal, suggesting that the underlying hypothyroidism had aggravated his gout condition.
References
Dhoble A, Balakrishnan V, Smith R. Chronic tophaceous gout presenting as acute arthritis during an acute illness: a case report. Cases J 2008; 1(1): 238.
Logan JA, Morrison E, McGill PE. Serum uric acid in acute gout. Ann Rheum Dis 1997; 56(11): 696-7.
Mikuls TR, Saag KG. New insights into gout epidemiology. Curr Opin Rheumatol 2006; 18(2): 199-203.
Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol 2012; 23(1): 22-6.
Perez-Ruiz F, Dalbeth N, Bardin T. A review of uric acid, crystal deposition disease, and gout. Adv Ther 2015; 32(1): 31-41.
Falidas E, Rallis E, Bournia VK, Mathioulakis S, Pavlakis E, Villias C. Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report. J Med Case Rep 2011; 5: 397.
Sarma P, Das D, Deka P, Deka AC. Subconjunctival urate crystals: a case report. Cornea 2010; 29(7): 830-2.
Iacobellis G, Iacobellis G. A rare and asymptomatic case of mitral valve tophus associated with severe gouty tophaceous arthritis. J Endocrinol Invest 2004; 27(10): 965-6.
Neogi T. Clinical practice. Gout. N Engl J Med 2011; 364(5): 443-52.
Forbess LJ, Fields TR. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum 2012; 42(2): 146-54.
See LC, Kuo CF, Yu KH, Luo SF, Chou IJ, Ko YS, et al. Hyperthyroid and hypothyroid status was strongly associated with gout and weakly associated with hyperuricaemia. PLoS One 2014; 9(12): e114579.
Khan AH, Majumder I, Hoque M, Forhadul F, Mollah H, Arslan I. Serum Creatinine and Uric Acid Levels in Hypothyroid Patients: A Cross Sectional Study. J Enam Med Col 2013; 3(2): 84-7.
Giordano N, Santacroce C, Mattii G, Geraci S, Amendola A, Gennari C. Hyperuricemia and gout in thyroid endocrine disorders. Clin Exp Rheumatol 2001; 19(6): 661-5.
Shidham V, Chivukula M, Basir Z, Shidham G. Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. Mod Pathol 2001; 14(8): 806-10.
Shidham V, Shidham G. Staining method to demonstrate urate crystals in formalin-fixed, paraffin-embedded tissue sections. Arch Pathol Lab Med 2000; 124(5): 774-6.
Peh WC. Tophaceous gout. Am J Orthop (Belle Mead NJ) 2001; 30(8): 665.
Gentili A. Advanced imaging of gout. Semin Musculoskelet Radiol 2003; 7(3): 165-74.
Schueller-Weidekamm C, Schueller G, Aringer M, Weber M, Kainberger F. Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings. Eur J Radiol 2007; 62(3): 437-43.
Thiele R, Schlesinger N. Ultrasonography is a reli- able, non-invasive method for diagnosing gout. Arthritis Rheum 2005; 52(suppl 9): S809.
Schlesinger N. Diagnosis of gout: clinical, laboratory, and radiologic findings. Am J Manag Care 2005; 11(15 Suppl): S443-S450.
Schumacher HR, Jr., Becker MA, Edwards NL, Palmer WE, MacDonald PA, Palo W, et al. Magnetic resonance imaging in the quantitative assessment of gouty tophi. Int J Clin Pract 2006; 60(4):
-14.
