A 60-year-old Black woman with a history of stage 3 chronic kidney disease, type 2 diabetes and hypertension presented with a 12-month history of asymmetric polyarthritis of the wrists, metacarpophalangeal (MCP), proximal interphalangeal (PIP), metatarsophalangeal (MTP) and knee joints. The review of systems was unremarkable. She denied oral ulcers, rashes, alopecia, or a history of…
From the first substantial argument in the 19th century that uric acid played a role in gout, it took about 100 years for the medical community to accept its role in triggering acute inflammatory gout attacks. Two papers, both published in 1962, helped demonstrate the link between uric acid and acute gout attacks, quickly opening…
At this EULAR 2022 session, one expert explains why he believes refractory gout is caused by mismanagement and discussed ways around treatment obstacles.
New analyses of treat to target in gout may lead to revisions in some guidelines.
Although the diagnosis and treatment of gout are sometimes straightforward, practitioners encounter challenges in patients with atypical presentations, as well as those with medically complex situations or refractory disease. Here, gout experts share insights into some of these scenarios. Flare in Hospitalized Patients When not contraindicated, the 2020 ACR Guideline for the Management of Gout…
Erosive Polyarticular Chronic Tophaceous Gout in a Young Man A 27-year-old man was referred to us for joint pain and nodular swelling over multiple joints. His symptoms started when he was 13 years old, but he was sub-optimally treated. On examination, we found marked digital deformity, with multiple large tophi over the small joints of…
Lipoma arborescens is a rare, benign intra-articular lesion characterized by diffuse replacement of synovial tissue by mature adipocytes, causing a villous lipomatous proliferation of the synovial membrane.1 Typically, this is a monoarticular condition, with the knee being the most commonly affected although it has been rarely reported to occur in an oligo-/polyarticular fashion and in…
The research presented at ACR Convergence 2021 had a broad scope. Below are details on three studies that addressed cardiovascular safety in treat-to-target strategies, phase 2 study results on the efficacy of tigulixostat and the impact of patient preference on treatment adherence. Take our quiz after you read this article. Treat to Target Abstract L06:…
The 2020 ACR Guideline for the Management of Gout is intended to provide guidance for the management of patients with gout, and includes recommendations on the indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations.1 The guideline includes 42 recommendations, of which 16 are strong….
Gout affects more than 9.2 million adults in the U.S. and is the most common form of inflammatory arthritis. This condition and its complications are painful and potentially disabling with varying risk factors. It is characterized by symptoms that are usually sudden, with intense episodes of painful swelling in one or more joints, most often…