Chronic Tophaceous Gout Treated Mistakenly as Rheumatoid Arthritis for One Year

Hasan Ulusoy,Ayhan Kamanli,Arif Gulkesen,Gurkan Akgol

doi:10.29333/ejgm/82484

Hasan Ulusoy, Ayhan Kamanli + Show 2 more

Open Access

https://doi.org/10.29333/ejgm/82484

Copy DOI

Abstract

Gout is a common disorder characterized by hyperuricemia and the deposition of monosodium urate crystals in various tissues. Clinical manifestations of gout include attacks of acute inflammatory arthritis, a chronic destructive arthropathy known as chronic tophaceous gout, and non-articular accumulation of monosodium urate crystals crystals suchs as tophi and kidney stones. Acute gouty arthritis usually begins with one joint in the lower limbs, such as first metatarsophalangeal joint, midtarsi, ankles and knees. Subsequent attacks frequently last longer than does the first attack, affect several joints, and are prone to spread to the upper limbs, especially to small joints of the hands. Although acute gouty arthritis is familiar for most physicians chronic gouty arthritis which affects small joints of the hands can be difficult to distinguish from other common interphalangeal arthropathies such as rheumatoid arthritis, psoriatic arthritis and erosive osteoarthritis. Because of very similar presentations, an awareness of the differential diagnosis, as well as a combination of clinical, radiographic, and laboratory findings is necessary to differentiate these diseases. Here we describe a case of chronic tophaceous gout who had been treated mistakenly as rheumatoid arthritis for one year.

Highlights

Gout is a heterogeneous disorder characterized by hyperuricemia and the deposition of monosodium urate (MSU) crystals in and around the joints (1)
Acute gouty arthritis usually begins with one joint in the lower limbs, such as first metatarsophalangeal joint, midtarsi, ankles and knees
Acute gouty arthritis is familiar for most physicians chronic gouty arthritis which affects small joints of the hands can be difficult to distinguish from other common interphalangeal arthropathies such as rheumatoid arthritis, psoriatic arthritis and erosive osteoarthritis

Summary

Bir Yıl Romatoid Artrit Olarak Takip Edilen Kronik Tofüsllü Gut

Gut hiperürisemi ve monosodyum ürat kristallerinin çeşitli dokularda çökmesi ile karakterize yaygın bir hastalıktır. Gutun klinik görünümleri akut inflamatuvar artrit ataklarını, kronik tofüslü gut olarak bilinen kronik destrüktif bir artropatiyi ve monosodyum ürat kristallerinin tofüs ve böbrek taşları gibi eklem dışı birikimlerini içerir. Akut gut artriti sıklıkla birinci metatarsofalangeal, midtarsal, ayak bileği ve diz eklemi gibi alt ekstremite eklemlerinden birinde başlar. Sonraki ataklar sıklıkla ilk atağa göre daha uzun sürer ve birden fazla eklemi etkiler, üst ekstremite ve özellikle elin küçük eklemlerine yayılma eğilimindedir. Akut gut artriti çoğu hekim için tanıdık olsa da, elin küçük eklemlerini etkileyen kronik gut artritinin romatoid artrit, psöriatik artrit ve eroziv osteoartrit gibi diğer yaygın interfalangeal artropatilerden ayırımı zor olabilmektedir. Biz bu yazıda bir yıldır yanlışlıkla romatoid artrit olarak tedavi edilmiş bir kronik tofüslü gut olgusu sunuyoruz.

INTRODUCTION

Differential diagnosis of gouty arthritis

Findings

DISCUSSION