Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

Objective: Gout and cardiovascular disease are closely related, but the mechanism connecting them remains unknown. This study aims to explore whether urate crystal deposits and inflammation (assessed by ultrasound) are associated with carotid atherosclerosis.Methods: We included consecutive patients with crystal-proven gout newly presenting to a tertiary rheumatology unit. Patients under urate-lowering treatment were excluded. Ultrasound assessment was performed during intercritical periods. Musculoskeletal scans evaluated six joints and four tendons for urate crystal deposits (double contour, aggregates, and tophi), and power Doppler (PD) signal (graded 0–3) as a marker of local inflammation. The sum of locations showing deposits or a positive PD signal (≥1) was registered. Carotids were scanned for increased intima-media thickness (IMT) and atheroma plaques, according to the Mannheim consensus. Associations were analyzed using logistic regression.Results: The study included 103 patients showing sonographic crystal deposits at the examined locations (mean sum 9.9, minimum 2); tophi were the most frequent. Two-thirds of participants presented a positive PD signal (30.1% grade 2–3). In the carotid scans, 59.2% of participants showed atheroma plaques, and 33.0% increased IMT. Tophi (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03–1.50) and a positive PD signal (OR 1.67; 95% CI 1.09–2.56) were significantly associated with atheroma plaques, while an increased IMT showed no sonographic association.Conclusion: Sonographic crystal deposits and subclinical inflammation were consistently observed in patients with intercritical gout. Tophi and a positive PD signal were linked to carotid atherosclerosis. Our findings may contribute to understanding the complex relationship between gout and atherosclerosis.

Pathologic Fracture of The Patella Secondary to a Gouty Tophus

Gout is a rare cause of patellar fracture, with few documented cases. We report a case of gout tophi in the patella, the severe transverse fracture resulting from minor trauma. The patient was managed by the same treatment principles used for patients with nonpathologic patella fractures. We preformed excising the mass, fixing the bone fragment and filling in bone defect with allograft bone. Union of the fracture was seen at three months follow-up. The patient has recovered completely and returned to his former work after 3 months postoperatively.

Images in clinical medicine: gouty arthritis with osteomyelitis

Gout is one of the most common inflammatory arthropathies, characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues and leading to inflammation. The natural history of articular gout is typically composed of four periods: asymptomatic hyperuricemia, episodes of acute attacks of gout (acute gouty arthritis) with asymptomatic intervals (intercritical gout), and chronic tophaceous gout. Tophi develop in 12-35% of gouty patients without adequate control of uricemia. Initially, they do not cause significant complaints or function limitation of the nearby joints. However, if they become larger, joint instability and movement range limitation, joint function impairment and bone erosions and infection at the sites of their penetration can develop.We report a case of a poorly controlled polyarticular tophaceous gout complicated by osteomyelitis.