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Beyond Medical Treatment: Surgical Treatment of Gout

  • Crystal Arthritis (M Pillinger & M Toprover, Section Editors)
  • Published:
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Abstract

Purpose of Review

Medical treatment with urate-lowering therapy (ULT) is efficacious. A recent publication suggested that surgery in gout is more prevalent than previously reported. This revelation led us to review what is known about surgical treatment of gout.

Recent Findings

The Google Scholar database (January 1, 2014–January 1, 2020) found 104 publications with a total of 169 gout patients, with an average disease duration of 6.7 years. Most (68%) were not on ULT. The mean pre-operative serum urate levels were 9.19 mg/dL. One hundred thirteen patients underwent tophi excision, while in 33 patients, tophi were found during surgery. The majority of the surgeries were performed in Asia and Europe.

Summary

Most patients were not taking ULT at the time of surgery, leading to hyperuricemia. This can result in tophi reformation post-surgery. The role of surgery should be a last-line treatment and until recently has only been demonstrated through case reports.

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Authors and Affiliations

  1. Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Jonathan Carcione & Shari Bodofsky

  2. Horizon Therapeutics, Lake Forest, USA

    Brian LaMoreaux

  3. Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School Gout Center, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Naomi Schlesinger

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  1. Jonathan Carcione
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  2. Shari Bodofsky
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  3. Brian LaMoreaux
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  4. Naomi Schlesinger
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All authors take responsibility for the integrity of the review. JC and NS drafted the initial manuscript. NS and BL provided critical review. All authors reviewed and provided input at each step.

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Correspondence to Jonathan Carcione.

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JC and SB declare that they have no conflict of interest. BL receives consulting fees from Horizon Therapeutics. NS receives research grant funding from AMGEN and consulting fees from Horizon Therapeutics, IFM Therapeutics, and Johnson & Johnson.

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Carcione, J., Bodofsky, S., LaMoreaux, B. et al. Beyond Medical Treatment: Surgical Treatment of Gout. Curr Rheumatol Rep 23, 1 (2021). https://doi.org/10.1007/s11926-020-00969-6

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