Deforming Gout
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《新英格兰医药杂志》
An 80-year-old man with a 30-year history of gout was referred to the rheumatology clinic for further treatment. He had received colchicine and urate-lowering drugs intermittently over the previous several years. Clinical examination revealed multiple tophi on the hands (Panel A), feet, knees, and auricular surfaces. Some of the tophi exuded a white, chalky material. Laboratory studies were notable for a serum uric acid level of 8.5 mg per deciliter (506 μmol per liter), urinary urate excretion of 350 mg per day (2 mmol per day), and a creatinine clearance rate of 39 ml per minute per 1.73 m2 of body-surface area. A radiographic evaluation (Panel B) demonstrated soft-tissue swellings (arrowhead) and para-articular erosions and overhanging margins (arrows) involving the wrist, metacarpophalangeal joints, ulna, proximal and distal interphalangeal joints, and metatarsophalangeal joints. Polarized light microscopy (inset) showed a myriad of extracellular urate crystals. The patient was treated with nonsteroidal antiinflammatory drugs, low-dose colchicine, and allopurinol. He improved over the following year.
Gonzalo Pacheco, M.D.
Javier A. Cavallasca, M.D.
Hospital de Clínicas José de San Martín
Buenos Aires, Argentina
Gonzalo Pacheco, M.D.
Javier A. Cavallasca, M.D.
Hospital de Clínicas José de San Martín
Buenos Aires, Argentina