This finger tophi review looks at a case study of advanced tophaceous gout causing loss of a finger through amputation.
Tophi are deposits of uric acid crystals that frequently occur under the skin, but can spread throughout the body. Unfortunately, tophi can grow and spread without the usual painful gouty arthritis most commonly associated with uric acid crystals. This often results in gout not being diagnosed properly.
Gouty Fingers Case Study
This is a layman’s review of:
- Erosive polyarticular tophaceous gout: an unusually deforming and destructive presentation.
- Redmond CE, Babiker A, Redmond PL, O’Rourke KP.
- BMJ Case Rep. 2013 Dec 10;2013.
Polyarticular means occurring in multiple joints.
Tophaceous gout is where gout has progressed to the stage where tophi are visible.
The case study contains a description, learning points, and references. It contains a photograph and an x-ray image. For clarity, I have omitted the gout x-ray from this review, though it does show some significant bone erosion, particularly around the joints. The authors claim this to be more extensive than previous cases.[1-3]
Gouty Fingers Case Description
An 87 year old male suffered from painful, swollen and deformed fingers. He had longstanding gout, which led to amputation of the middle finger of his left hand. The report mentions suboptimal treatment of gout, but offers no further explanation.
The patient’s right index finger was swollen with multiple tophi. There was severe loss of movement in the joints of the fingers. There was almost complete destruction of the middle and end finger joints in both hands.
Blood tests revealed normal uric acid levels. However, we know from other research, that “normal uric acid levels” are meaningless in the clinical context of gout management. Analysis of a sample from the right index finger confirmed the presence of uric acid crystals.
Treatment was longterm colchicine at 1mg per day, and 600mg allopurinol per day.
Gouty Fingers Case Learning Points
The report lists 3 learning points, though it is not clear who needs to learn from them, as all 3 are well-documented prior to the date of this report.
- Advanced tophaceous gout can result from longterm untreated acute gout.
- Severe gouty tophi in many joints can occur even with normal uric acid and inflammation blood tests. If in doubt, joint fluid should be examined for uric acid crystals.
- Uric acid crystal deposits can lead to severe bone destruction, which may require amputation in rare cases.
Gouty Fingers: Next Steps
Though this case study does not reveal new information about gout, and how to manage it, it does emphasize the destructive nature of gout.
If you suspect gout, you really must take steps to get uric acid safe. Safe means 5mg/dL, or lower, and you need to take responsibility for it, as many medical practitioners are unaware of the dangers. Never settle for a normal uric acid test result. This gouty fingers case study confirms that if uric acid is not made safe, then bone destruction will happen.
Leave Finger Lost To Gout to browse other Finger Tophi pictures.
Gouty Fingers Case References
- Bloch C, Hermann G, Yu TF. A radiologic reevaluation of gout: a study of 2,000 patients. AJR Am J Roentgenol 1980;134:781–7.
- Samaras N, Rossi C. Images in clinical medicine. Tophaceous gout. N Engl J Med 2012;366:e6.
- Monu JUV, Pope TLJ. Gout: a clinical and radiologic review. Radiol Clin NA 2004;42:169–84.
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