Abstract
Gout continues to be a health problem around the world, and the treatment may turn into a real challenge when the patient presents a certain degree of chronic renal failure (CRF). We discuss a case of tophaceous gout in a 68-year-old male patient without urolithiasis and with uric acid (UA) underexcretion and CRF (creatinine clearance of 42 ml/min). Uricosuric treatment with benzbromarone and urinary alkalinization was administered, and acute gouty attacks improved substantially. Subsequently, allopurinol was added to the treatment to accelerate tophi reduction in the hands, feet, elbows and knees. After 30 months of treatment, serum UA declined from 10 to 3.2 mg/dl. Urinary UA excretion of 0.44 g/24 h in the baseline rose to 0.85 g/24 h, returning to the baseline value after 30 months. UA clearance tripled, rising from 3.05 ml/min before treatment to 9.48 ml/min, and remained at this level. It is worth stressing that even in cases of severe tophaceous gout, the response to clinical treatment may be satisfactory with substantial reduction of tophi and full acute gouty attack remission even in patients presenting a certain degree of CRF.
References
Kumar S, Gow P (2002) A survey of indications, results and complications of surgery for tophaceous gout. NZ Med J 115(1158):U109
Rott KT, Agudelo CA (2003) Gout. JAMA 289(21):2857–2860
Li EK (2004) Gout: a review of aetiology and treatment. Hong Kong Med J 10(4):261–270
Kumar S, Ng J, Gow P (2005) Benzbromarone therapy in management of refractory gout. NZ Med J 1217(118):U1528
Parmar MS (2002) Chronic renal disease. BMJ 325:85–89
Terkeltaub RA (2003) Gout. N Engl J Med 349(17):1647–1655
Emmerson BT (2003) The management of gout. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology. Mosby, London, pp 1929–1936
Gyula P, Mila M (2003) History, classification and epidemiology of crystal-related arthropathies. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology. Mosby, London, pp 1893–1901
Wortmann RL (2005) Recent advances in the management of gout and hyperuricemia. Curr Opin Rheumatol 17:319–324
Emmerson BT (1996) The management of gout. N Engl J Med 334(7):445–451
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Caldas, C.A.M., Fuller, R. Excellent response to the clinical treatment of tophaceous gout. Clin Rheumatol 26, 1553–1555 (2007). https://doi.org/10.1007/s10067-006-0444-6
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DOI: https://doi.org/10.1007/s10067-006-0444-6