Images in Clinical Rheumatology
Tophaceous gout in a woman
Gota tofácea en una mujer
María José Pérez Galán
, Celia García Jiménez
Corresponding author
Unidad de Reumatología, Complejo Hospitalario de Jaén, Jaén, Spain
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She states that she has consumed half a litre of alcohol-free beer per day for 15 years. She states that she has no history of arterial hypertension, no chronic disease and that she does not consume diuretics.</p><p id="par0010" class="elsevierStylePara elsevierViewall">She visited our surgery due to arthralgia in the hands and feet with a crisis of pain and functional impotency in multiple joints that has evolved over more than 15 years. Physical examination found major tophaceous deposits in the hands and feet, most strikingly in the right hand (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with incapacity of grasping, above all in the right hand.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Analysis detected 7.7 mg/dl uricaemia, while the rest of basic biochemistry was normal. The haemogram, acute phase reagents, rheumatoid factor and anti-citrulline antibodies were normal or negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Bone X-ray imaging showed an important increase in the soft parts, with trapping and erosion in the metacarpophalangeal, proximal and distal interphalangeal joints of both hands (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), as well as erosion on the first metatarsal joints and luxation of the 5th left metatarsal joint (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Tophaceous gout.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Evol ution</span><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment with hygienic and dietary methods was prescribed, with colchicine and an increased dose of allopurinol to maintain uricaemia below 5 mg/dl.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Gout arthropathy is more common in men<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> than it is in women, although it is the most frequent inflammatory disease of the joints in post-menopausal women. The first manifestation of the disease is typically acute arthritis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Tophi are sodium urate monohydrate deposits surrounded by a granulomatous inflammatory reaction. They are a pathognomic characteristic of gout and can be detected by physical examination and/or imaging techniques.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We present the case of a woman with tophaceous arthropathy. We recall the importance of maintaining suitable levels of uricaemia, as this disease is potentially disabling. We underline that although it occurs more frequently in men, it is the most common inflammatory arthropathy in post-menopausal women.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Evol ution" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-27" "fechaAceptado" => "2018-08-02" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez Galán MJ, García Jiménez C. Gota tofácea en una mujer. Reumatol Clin. 2020;16:506–507.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 61701 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tophaceous deposits in the hands.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 602 "Ancho" => 905 "Tamanyo" => 53310 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">X-ray image of hands: increased soft parts and erosion.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 927 "Ancho" => 905 "Tamanyo" => 84527 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">X-ray image of feet: erosion in the first metatarsophalangeal joints.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of gout in women: Fifty-two-year followup of a prospective cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Bhole" 1 => "Rahman M.M. de VM" 2 => "E. Krishnan" 3 => "H. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.27338" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2010" "volumen" => "62" "paginaInicial" => "1069" "paginaFinal" => "1076" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20131266" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Neogi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gout N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "443" "paginaFinal" => "452" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Tophi, mainly in articular, periarticular, bursal, bone, auricular, and cutaneous tissues are a pathognomonic feature of gout, and are detectable by physical exam, and/or by imaging approaches and pathology examination." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001600000006/v1_202011251719/S2173574320301167/v1_202011251719/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001600000006/v1_202011251719/S2173574320301167/v1_202011251719/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301167?idApp=UINPBA00004M" ]
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