Gout in tendon

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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In addition to the arthritis, gout causes the formation of tophi.

Tophi are lumpy deposits of uric acid crystals located under the skin. Common places for tophi to develop are in the outer edge of the ear, on or near the elbow, over the fingers and toes, and around the Achilles tendon in the ankle. Gout can also cause kidney stones made of uric acid.

It is not uncommon to see a patient who has gout and develops non-infective tenosynovitis. Three such cases of ‘sterile flexor tenosynovitis’ have been reported. It is important to differentiate gout from infection although they may coexist.

Diagnosis is made by synovial fluid examination for urate crystals and it is recommended that specimens are fixed in alcohol.

In 5–15% of cases of gouty arthritis, crystals may be absent in the synovial fluid aspiration and a synovial biopsy may be needed to confirm the diagnosis.

Gouty tenosynovitis in the hand can be present with no visible tophi or previous involvement of the upper extremeity, and is difficult to differentiate from infective tenosynovitis. Serum urate is often normal at the time of an acute attack of gout.

J Foot Ankle Surg. 1999 Sep-Oct;38(5):359-62.

Peroneus brevis tendon rupture with tophaceous gout infiltration.

De Yoe BE, Ng A, Miller B, Rockett MS.

Harris County Podiatric Surgical Residency Program, Houston, TX 77082, USA.

The authors present a patient with a history of chronic lateral ankle instability and pain. Physical and diagnostic evaluation revealed anterior ankle instability and peroneus brevis weakness. An MRI showed an attenuated anterior-talofibular ligament and a longitudinal tear of the peroneus brevis tendon. Surgical exploration exhibited tophaceous gout within the tear of the peroneus brevis as well as within the attenuated anterior-talofibular ligament. Presented is an unusual case of a longitudinal tear of the peroneus brevis tendon with tophaceous gout infiltration.

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