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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Community+Hosp+Intern+Med+Perspect
2017 ; 7
(2
): 136-137
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Images in clinical medicine: Tophi
#MMPMID28638581
Salama A
; Alweis R
J Community Hosp Intern Med Perspect
2017[Mar]; 7
(2
): 136-137
PMID28638581
show ga
Tophi (plural of tophus, Latin for "stone") are stone-like deposits of monosodium
urate in the soft tissues, synovial tissues, or in bones near the joints. They
are pathognomonic for gout, the most common inflammatory arthritis in the United
States, with an estimated lifetime prevalence of 4%. It is usually the end result
of loss of the balance between uric acid production and excretion. It can be
found anywhere in the body especially in areas of friction or trauma. It is
usually painless and rarely to present as the initial manifestation of gout. It
is diagnosed mainly clinically. Imaging is mainly used to assess the complication
like bony erosions. The American College of Rheumatology (ACR) guidelines
currently indicate that urate-lowering therapy should be initiated in patients
with the presence of tophi visible on examination or imaging (ACR Evidence A).
First-line therapy for urate lowering remains the xanthine oxidase inhibitor
allopurinol. The ACR currently recommends colchicine, 0.6 mg (or 0.5 mg) once or
twice daily, or low dose NSAIDs should be continued to reduce gout flare
incidence for six months after resolution of the tophus. Daily prednisone ?10 mg
has been endorsed as an acceptable second-line prophylactic agent. Abbreviations:
ACR: American College of Rheumatology; NSAID: non-steroidal anti-inflammatory
drug.
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