actually tophaceous gout. i saw it today in clinic. it was crazy. huge bony-looking growths on the olecranon process (elbow) and digits (fingers). it is cause by a deposit of monosodium urate crystals from an over production or under excretion of uric acid. it accumulates in the soft tissue, usually joints, especially the first metatarsophalyangeal joint (big toe). when this happens its called podegra. tophaceous gout occurse when tophi (bumps) appear on the joints, usually 12 years after they have had hyperuricemia.
acute treatment - NSAIDs or colchicine. colchicine you give at increasing doses until they have diarrhea, then you back the dose down a bit and keep them at that level. i prescribed colchicine tonight.
chronic treatment - keep the patient on NSAIDs or colchicine and treat the hyperuricemia, but not until the acute episode is over, or you can mobilize the crystals. typical drug is allopuronol.
my attending tonight told me to go home and look up this disease and the treatment because i saw it in clinic and would never forget it. i hope he is right. thanks RL, your huge tophi are engrained into my memory forever.
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