Abstract
Objectives: Tophi may occur within the knee joint causing limited knee-joint range of motion (knee motion). We investigated the relationships between knee motion, total intra-articular tophi size (tIA-tophi), and total subcutaneous tophi size (tSC-tophi) and determined knee motion improvement after continual urate-lowering therapy (ULT).Methods: A total of 26 patients with tophaceous gout and limited knee motion were enrolled. Inclusion criteria were age ≤ 60 years and preserved knee joint space on a plain radiograph. tSC-tophi were measured using a Vernier caliper and tIA-tophi were measured using magnetic resonance imaging software. All patients were re-evaluated after 12–24 months of continual ULT. Upon initial visit, knee motion was related to tIA-tophi and tSC-tophi.Results: After an average of 18.2 months of ULT, the reduction in tSC-tophi was correlated with the reduction in tIA-tophi (P = 0.014, r = 0.395) and improvement in knee motion (P = 0.038, r = 0.408). Knee motion can be eventually improved even in cases of poor initial knee motion (P = 0.000, r = –0.911) or large initial tIA-tophi (P = 0.014, r = 0.476). Tophi can occur in any location within the knee joint. In multiple lineal regression, knee motion was predicted to improve 8.39° for every 10cm of tIA-tophi reduction.Conclusions: Limited knee motion in patients with intra-articular tophi improved with medical treatment, regardless of initial severity. Furthermore, tSC-tophi can be used as an indicator of limited knee motion and their improvement as a predictor of knee motion improvement.
Highlights
Tophi typically occur many years after uncontrolled gouty arthritis and present in subcutaneous tissue [1]
Tophi occurring in knee joints can lead to limited knee-joint range of motion [4,5,6], resulting in knee deformity and walking difficulties and often been regarded as being due to knee osteoarthritis
Patients with gout and limited knee motion were unexpectedly found to have intra-articular tophi through magnetic resonance imaging (MRI) [4] and arthroscopy [5]
Summary
Tophi typically occur many years after uncontrolled gouty arthritis and present in subcutaneous tissue [1]. It can, occur in the absence of previous gout [2] and in unusual sites such as bones, tendons, and joints. Patients with gout and limited knee motion were unexpectedly found to have intra-articular tophi through magnetic resonance imaging (MRI) [4] and arthroscopy [5]. The treatment approach in such cases has been arthroscopic removal of the intra-articular tophi [5, 7], even with total knee arthroplasty [8, 9]. Further investigation is required to determine if urate-lowering therapy (ULT) is a favorable alternative to arthroscopic removal
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