In a retrospective review of MRIs from 30 patients with tophaceous gout
involving the knee, typical patterns and locations of MSU crystal deposition were characterized.
It has been licensed by the US Food and Drug Administration (FDA) for refractory tophaceous gout
However, if the patient has moderate tophaceous gout
or chronic gouty arthropathy, it's appropriate to place the patient on pegloticase (Krystexxa) while discontinuing all other urate-lowering agents.
According to the companies, KRYSTEXXA (pegloticase) is being marketed for the treatment of severe debilitating chronic tophaceous gout
in adult patients who may also have erosive joint involvement and who have failed to normalise serum uric acid with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these medicines are contraindicated.
Focal calcifications around joints similar to tophaceous gout
may be also seen in patients with pseudogout (Figure 5).
2-4) Tophaceous gout
, however, occurs in less than 10% of cases.
Urate oxidase (rasburicase) for treatment of severe tophaceous gout
Since this patient had a history of severe tophaceous gout
, his primary physician administered a shot of Depo-Medrol to relieve some of the pain caused by the gout flare.
On gross pathologic examination, tophaceous gout
deposits appear as yellow-white chalky material.
Savient's Krystexxa (pegloticase) launched in the United States in February 2011 for the small population of patients with chronic tophaceous gout
but, to date, has failed to earn substantial sales, due to its high price and tendency to induce neutralizing antibodies which limit the duration of effect.
1) In this article, we present a case of tophaceous gout
with destructive bony changes simulating malignancy in X-ray which, to the best of our knowledge, has not been reported previously.