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Chronic tophaceous gout as the first manifestation of gout in two cases and a review of the literature.

Abstract：

OBJECTIVES:Acute gout is a common arthritis that may eventually develop into chronic tophaceous gout (CTG). CTG usually is manifested by recurrent gout attacks. The diagnosis and treatment of CTG is challenging. Although the emergence of CTG without previous gout attacks is uncommon, it is important to recognize this unusual gout presentation. METHODS:Herein, we present two cases of CTG, occurring in elderly patients with chronic kidney disease (CKD) on diuretics, who presented without a prior history of acute gout attacks. We also searched PUBMED, Ovid MEDLINE, and Google scholar (1970-2017), for "tophi as the initial manifestation of gout" and "chronic gout without previous attacks", and extracted relevant data. RESULTS:The search disclosed one retrospective study and several case reports and case series describing 96 patients. Clinical and laboratory data was extracted from 34 patients. We found that a specific group of patients, e.g., elderly patients, most often female patients, suffering from CKD, and treated with diuretics, are specifically reported in the English medical literature to present with CTG as their first manifestation of gout. CONCLUSION:The two cases and our literature review try to emphasize the many faces of chronic gout, in particular, its presentation without previous gout attacks.

journal_name

Semin Arthritis Rheum

journal_title

Seminars in arthritis and rheumatism

authors

Bieber A,Schlesinger N,Fawaz A,Mader R

doi

10.1016/j.semarthrit.2017.11.006

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

843-848

issue

6

eissn

0049-0172

issn

1532-866X

pii

S0049-0172(17)30539-5

journal_volume

47

pub_type

杂志文章,评审

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