Tophaceous gout treatment when medication is not enough

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Tophaceous gout treatment when medication is not enough

Gout is a painful and potentially debilitating condition that develops in some people who have chronically high blood levels of uric acid. It is not necessary that high blood urate levels (hyperuricemia) results in gout. Up to two-thirds of individuals with hyperuricemia never develop gout. Patients with severe tophaceous gout who are at risk for complications including permanent joint destruction and who have not responded to medical management may benefit from surgery. To review the literature concerning surgical intervention of tophaceous gout and propose clinical circumstances for when it may be considered, a study has been conducted.

Usually, tophi develop in approximately 12-35% of patients with gout. Tophaceous disease is usually preventable given the availability of effective urate lowering therapies (ULT) including allopurinol, febuxostat, probenecid, lesinurad and pegloticase. Despite medical therapy, there remains a subset of patient who developed significant complications of tophi including infection, ulceration and entrapment neuropathy. Tophi, in close proximity to joints can cause joint instability, severely limited range of motion and significant functional impairment.

A trial has been conducted, in which the review was based on the all available series of surgery for tophaceous gout using Medline and Google Scholar. In analysis, 7 published surgical series were identified. Six out of 7 series were published between 2002 and 2014. Results indicated that there were positive outcomes of surgical interventions for tophaceous gout without major post-surgical complications

After analysis, it was concluded that medical therapy with urate lowering therapies should be considered as the first line approach to tophaceous gout, surgery for rare patient with impending or severe, debilitating complications including infections, entrapment neuropathy or those risk for permanent joint destruction. In these selected clinical circumstances, surgical intervention for tophaceous gout might be appropriate. 

Semin Arthritis Rheum.
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