A Patient Presenting with Joint Deformities and ST-Elevation Myocardial Infarction
Emil J Dąbrowski1, Wiktoria U Kozłowska1, Patrycja O Lipska1
1Department of Invasive Cardiology, Medical University of Białystok, 15-089 Białystok, Poland.
Diagnostics (Basel, Switzerland)
|September 13, 2025
Summary
This case study shows that severe tophaceous gout can lead to serious heart and kidney problems, even with standard treatment. Advanced therapies may be needed for refractory gout with multi-organ involvement.
Area of Science:
- Rheumatology
- Cardiology
- Nephrology
Background:
- Tophaceous gout, a severe form of gout, is associated with significant systemic complications.
- Patients with refractory gout often have comorbidities like cardiovascular and renal disease.
- Long-term urate-lowering therapy may not always prevent disease progression in severe cases.
Purpose of the Study:
- To present a case of ST-elevation myocardial infarction in a patient with advanced, treatment-refractory tophaceous gout.
- To highlight the cardiovascular and renal sequelae of severe gout.
- To discuss the management of refractory tophaceous gout with multi-organ involvement.
Main Methods:
- A 62-year-old male patient with a history of chronic kidney disease, hypertension, heart failure, and atrial fibrillation presented with ST-elevation myocardial infarction.
- Coronary angiography revealed multivessel disease, treated with percutaneous coronary intervention.
- The patient underwent hybrid coronary artery bypass grafting and left atrial appendage occlusion.
Main Results:
- The patient had advanced tophaceous gout with severe joint deformities and tophi despite urate-lowering therapy.
- He experienced ST-elevation myocardial infarction and multivessel coronary artery disease.
- Despite initial interventions, disease progression necessitated consideration of advanced therapies like pegloticase and canakinumab.
Conclusions:
- Treatment-refractory tophaceous gout poses a systemic burden, leading to progressive cardiovascular and renal complications.
- Tophaceous gout is a high-risk phenotype associated with increased mortality and reduced quality of life.
- Multidisciplinary care and personalized strategies are crucial for managing severe, refractory gout with multi-organ involvement.
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