We have seen how gouty tophi grow predominantly beneath the skin. However, they can occur anywhere in the body, and this gout study shows a tophus growing into the finger bone.
This is a layman’s review of a gout patient case report:
- Intraosseous tophaceous gout in the proximal phalanx of the small finger.
- Oti FE, Reichert B, Bär I.
- J Hand Surg Eur Vol. 2012 Sep;37(7):696-7.
Intraosseous tophaceous gout means tophaceous gout that grows into the bone.
Gouty Tophi In Finger Bone Case Report
The doctors report case details of an 88 year old man who had 2 weeks of persistent tenderness and swollen inflammation of the right little finger. It did not respond to (paracetamol), prednisolone, and rest.
The patient had no history of gout, but long history of kidney disease. X-rays revealed nothing, but blood tests revealed 12mg/dL uric acid. Colchicine supported with other pain control failed to give complete relief.
MRI showed a tumor growing into the finger bone. Surgery was performed, as doctors could not be certain that the growth was not cancerous. It was revealed as a tophaceous deposit growing into the bone.
Gouty Tophi In Finger Bone Opinion
Normal first line treatment for tophi is aggressive uric acid lowering. In this case, the true nature of the growth was hard to identify. Tophaceous deposits rarely show on X-ray, and though MRI reveals the growth, it does not identify the exact problem. In this case, surgery was deemed to be the best option to identify and remove the tumor in one operation.
The report highlights:
- Tophi grow slowly, and may not trigger a gout attack.
- Tophi are not limited to soft tissues.
- Tophi are difficult to identify.
- Surgery is often the most realistic option for tophi removal
Gouty Tophi In Finger Bone: Next Steps
If you have any unusual growths, which may or may not be accompanied by swelling, gout is suspected if no obvious alternative is revealed by X-ray.
Immediate treatment by very low uric acid might be available, otherwise you can expect surgery.