Experience of arthroscopic surgery in tophaceous gout: indications, results and complications

Experience of arthroscopic surgery in tophaceous gout: indications, results and complications

Автор: Tan Wei, Chen Jianchun, Ran Ran, Zheng Wuyan, Oshmianska Nataliia

Журнал: Гений ортопедии @geniy-ortopedii

Рубрика: Оригинальные статьи

Статья в выпуске: 1 т.27, 2021 года.

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Background Gout, lasting 5 years or more, and high uncontrollable levels of uric acid in blood lead to the formation of tophi - gouty stones containing the UA crystals surrounded with connective tissue. As the result of tophi formation in the joint area patients felt extreme discomfort and quite often completely lose ability to work. Objectives To define indications for tophaceous gout surgery in the Chengdu Rheumatism Hospital, evaluate surgical results and complications, as well as the effectiveness of a new surgery equipment. Materials and methods The indications and results of tophaceous gout surgery were investigated in 63 male gout patients of Chengdu Rheumatism hospital in 2019-2020. A retrospective analysis was carried out on the basis of medical records for all patients who were prescribed with urate lowering therapy and underwent arthroscopic intervention or complex surgical intervention combining arthroscopic shaving with open tophectomy procedure. Results The most common lesion site was foot joints: toes (49.41 %), ankle (39.68 %) and knee (34.92 %), with restricted mobility in the mentioned joints. Among common complaints were inability to perform daily routines due to enlarged joints (inability to wear shoes), joints’ dysfunction and pain. Younger patients (aged 20-44) had significantly higher levels of uric acid in serum before treatment. In most cases, indications for surgery for this group of patients were pain and discomfort in joints, inability to perform daily work. After accessing pain levels, 38.46 % of younger patients reported pain leveled 6 or higher on VAS score, which was more often, compared to patients aged 45-55 (26.92 %) and older than 55 (10.0 %). After surgery and following urate lowering therapy all patients noted functional improvement and reduction of pain. Decrease in serum urate levels were reported in 96.83 % of patients. Conclusion The results of surgical treatment for functional impairment of the joint (inability to perform daily work due to restricted range of motions) and massive joint transformation (inability to wear shoes/clothes) in gout patients are positive, with all patients reporting functional improvement and reduction of pain, and the risk of complications is low. In addition to urate lowering therapy we cautiously recommend performing arthroscopic shaving even in younger gout patients consistent with aforementioned indications.

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Gout, hyperuricemia, tophi, arthroscopic shaving

Короткий адрес: https://sciup.org/142230208

IDR: 142230208   |   DOI: 10.18019/1028-4427-2021-27-1-55-58

Список литературы Experience of arthroscopic surgery in tophaceous gout: indications, results and complications

  • Mandell B.F. Clinical manifestations of hyperuricemia and gout. Cleve Clin. J. Med., 2008, no. 75 Suppl 5, pp. S5-S8. DOI: 10.3949/ccjm.75.suppl_5.s5
  • Dehlin M., Jacobsson L., & Roddy E. Global epidemiology of gout: Prevalence, incidence, treatment patterns and risk factors. at. Rev. Rheumatol., 2020, Vol. 16, no. 7, pp. 380-390.
  • McLean L., Becker M. Etiology and pathogenesis of gout. In: M.C. Hochberg, A.J. Silman, J.S. Smolen, M.E. Weinblatt, M.H. Weisman, eds. Rheumatology. Elsevier Ltd., Mosby, 2011, Section 14, No 187, pp. 1555.
  • Puig J.G., Martínez M.A. Hyperuricemia, gout and the metabolic syndrome. Curr. Opin. Rheumatol., 2008, vol. 20, no. 2, pp. 187-191. DOI: 10.1097/ B0R.0b013e3282f4b1ed
  • Khanna P.P., Nuki G., Bardin T., Tausche A.K., Forsythe A., Goren A., Vietri J., Khanna D. Tophi and frequent gout flares are associated with impairments to quality of life, productivity, and increased healthcare resource use: Results from a cross-sectional survey. Health Qual. Life Outcomes, 2012, vol. 10, pp. 117. DOI: 10.1186/1477-7525-10-117
  • McQueen F.M., Chhana A., Dalbeth N. Mechanisms of joint damage in gout: evidence from cellular and imaging studies. Nat. Rev. Rheumatol., 2012, vol. 8, no. 3, pp. 173-181. DOI: 10.1038/nrrheum.2011.207
  • Ragab G., Elshahaly M., Bardin T. Gout: An old disease in new perspective - a review. J. Adv. Res., 2017, vol. 8, no. 5, pp. 495-511. DOI: 10.1016/j. jare.2017.04.008
  • Kasper I.R., Juriga M.D., Giurini J.M., Shmerling R.H. Treatment of tophaceous gout: When Medication is not enough. Semin. Arthritis Rheum., 2016, vol. 45, no. 6, pp. 669-674. DOI: 10.1016/j.semarthrit.2016.01.005
  • Kumar S., Gow P. A survey of indications, results and complications of surgery for tophaceous gout. N. Z. Med. J., 2002, vol. 115, no. 1158, pp. U109.
  • Wang C.C., Lien S.B., Huang G.S., Pan R.Y., Shen H.C., Kuo C.L., Shen P.H., Lee C.H. Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout. Arthroscopy, 2009, vol. 25, no. 2, pp. 153-158. DOI: 10.1016/j.arthro.2008.09.002
  • Khanna D., Fitzgerald J.D., Khanna P.P., Bae S., Singh M.K., Neogi T., Pillinger M.H., Merill J., Lee S., Prakash S., Kaldas M., Gogia M., Perez-Ruiz F., Taylor W., Lioté F., Choi H., Singh J.A., Dalbeth N., Kaplan S., Niyyar V., Jones D., Yarows S.A., Roessler B., Kerr G., King C., Levy G., Furst D.E., Edwards N.L., Mandell B., Schumacher H.R., Robbins M., Wenger N., Terkeltaub R.; American College of Rheumatology. American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. (Hoboken), 2012, vol. 64, no. 10, pp. 1431-1446. DOI: 10.1002/acr.21772
  • Edwards N.L. Treatment-failure gout: a moving target. Arthritis Rheum., 2008, vol. 58, no. 9, pp. 2587-2590. DOI: 10.1002/art.23803
  • Lee S.S., Chen M.C., Chou Y.H., Lin S.D., Lai C.S., Chen Y.C. Timing of intra-lesion shaving for surgical treatment of chronic tophus. J. Plast. Reconstr. Aesthet. Surg., 2013, vol. 66, no. 8, pp. 1131-1137. DOI: 10.1016/j.bjps.2013.03.041
  • Oztürk R., Atalay Í.B., Bulut E.K., Beltir G., Yilmaz S., Güngor B.§. Place of orthopedic surgery in gout. Eur. J. Rheumatol., 2019, vol. 6, no. 4, pp. 212-215. DOI: 10.5152/eurjrheum.2019.19060
  • Atakhanova L.E., Tsurko V.V., Buleva I.M., Boiko I.N., Zheleznov S.P., Ivanova T.B. Podagra: Ot etiologii i patogeneza k diagnostike i ratsionalnoi farmakoterapii [Gout: From etiology and pathogenesis to diagnosis and rational pharmacotherapy]. Sovremennaia Revmatologiia, 2007, vol. 1, no. 1, pp. 13-18. (in Russian) DOI: 10.14412/1996-7012-2007-433
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