Case study: a case of debilitating gout in the 1st metatarsophalangeal joint.
Gout is a painful arthritic condition that affects many people worldwide. The disease has been associated with hyperuricaemia and life style risk factors such as obesity, alcohol intake, meat and seafood consumption. We present a case of a 67-year-old male with a history of gout, who attended the clinic with a painful 1st metatarsophalangeal joint, which had progressively worsened in pain, mobility and deformity in the last 20 years. Although lifestyle changes had been advised by the GP some years earlier such as a low purine based diet, management had only consisted of NSAID's, which had not significantly improved symptoms. Surgical excision of chalky white material from around the 1st metatarsophalangeal joint rendered the patient symptom free with increased mobility after 6 weeks. Histopathology confirmed the excised tissue as gouty tophus. Following this, the patient was placed on allopurinol, a xanthine oxidase inhibitor to prevent recurrent attacks. This case study highlights the importance of early recognition and prophylactic management in gout sufferers. In joints where the disease process is well-established surgical excision of the gouty tophus may help mitigate further disease progression, and restore quality of life to individuals.
Department of Podiatric Surgery, Turner Centre, St James Hospital, Locksway Road, Portsmouth PO4 8LD, UK. Electronic address: natalie.tanner@solent.nhs.uk.
Natalie
N
Tanner
Department of Podiatric Surgery, Turner Centre, St James Hospital, Locksway Road, Portsmouth PO4 8LD, UK.
Ross
R
Diaper
Department of Podiatric Surgery, Turner Centre, St James Hospital, Locksway Road, Portsmouth PO4 8LD, UK.
Mathew
M
King
Department of Podiatric Surgery, Turner Centre, St James Hospital, Locksway Road, Portsmouth PO4 8LD, UK.
Stuart A
SA
Metcalfe
D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D015210:Arthritis, Gouty / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint
D006074:Gout Suppressants; D000493:Allopurinol
Gout; Hyperuricaemia; Management; Purines; Tophus