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Related Experiment Videos

Intradermal tophi in gout: a case-control study

J Vázquez-Mellado1, A Cuan, M Magaña

  • 1Rheumatology and Dermatology Units, Hospital General de México, SS, México City.

The Journal of Rheumatology
|January 26, 1999
PubMed
Summary

Intradermal tophi in gout patients are often found on legs and forearms. Their development is linked to long-term glucocorticoid use and chronic kidney issues, indicating advanced disease.

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Area of Science:

  • Rheumatology
  • Dermatology
  • Nephrology

Background:

  • Gout is a form of inflammatory arthritis characterized by hyperuricemia and deposition of monosodium urate (MSU) crystals.
  • Tophi, which are MSU crystal aggregates, typically form in subcutaneous tissues near joints.
  • Intradermal tophi, distinct from subcutaneous ones, represent a less common manifestation of gout.

Purpose of the Study:

  • To characterize the clinical presentation of intradermal tophi in gout patients.
  • To identify factors associated with the development of intradermal tophi.

Main Methods:

  • A case-control study design was employed, comparing patients with intradermal tophi (cases) to those with gout but without intradermal tophi (controls).
  • Cases and controls were matched for sex, age, and disease duration.

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  • Data collected included serum/urinary uric acid levels, radiographic gout stage, comorbidities, and medication history (glucocorticoids, diuretics).

    • Main Results:

    • Intradermal tophi were predominantly located on the legs and forearms, but also found on buttocks, thighs, arms, and the abdominal wall.
    • Patients with intradermal tophi had significantly more subcutaneous tophi, reduced glomerular filtration rate (chronic kidney disease), advanced radiographic changes, and a history of long-term self-medication with glucocorticoids.
    • No significant differences in other associated diseases were observed between groups.

    Conclusions:

    • Intradermal tophi in gout patients are associated with more severe and advanced disease, including chronic kidney disease and extensive subcutaneous tophi.
    • Long-term self-prescription of glucocorticoids is a significant factor in the development of intradermal tophi.
    • The presence of intradermal tophi suggests a need for closer monitoring and management of advanced gout.