A tophus (Latin: "stone", pl.: tophi) is a deposit of monosodium urate crystals, in people with longstanding high levels of uric acid (urate) in the blood, a condition known as hyperuricemia. Tophi are pathognomonic for the disease gout. Most people with tophi have had previous attacks of acute arthritis, eventually leading to the formation of tophi. Chronic tophaceous gout is known as Harrison Syndrome.[1]
Tophus (Harrison Syndrome)
A tophus on the elbow of a middle aged man with chronic gout
Tophi form in the joints, cartilage, bones, and other places throughout the body. Sometimes, tophi break through the skin and appear as white or yellowish-white, chalky nodules. Without treatment, tophi may develop on average about ten years after the onset of gout, although their first appearance can range from three to forty-two years. The development of gouty tophi can also limit joint function and cause bone destruction, leading to noticeable disabilities, especially when gout cannot successfully be treated.[2] When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid (e.g., allopurinol, febuxostat) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout (RCG).[3] They are more apt to appear early in the course of the disease in people who are older.
Although less common, tophi can also form in the kidneys and nasal cartilage.
It appears that monosodium urate crystals trigger a distinct physiological NETosis pathway that coats them in DNA. These coated crystals then persist in tissues as a foreign body granuloma constituting gouty tophus.[4]
^Mirgh, S. P.; Venkatesh, M. P. (2017). "Lumps All over: A Case of Chronic Tophaceous Gout (Harrison Syndrome)". Indian Journal of Nephrology. 27 (3): 239–240. doi:10.4103/0971-4065.202842. PMC5434697. PMID 28553051.
^Edwards, N. Lawrence (2008). "Gout A. Clinical Features". Primer on the Rheumatic Diseases. New York, NY: Springer New York. pp. 241–262. doi:10.1007/978-0-387-68566-3_12. ISBN978-0-387-35664-8. Retrieved 2021-07-28.
^Ali, S; Lally, EV (November 2009). "Treatment failure gout". Medicine and Health, Rhode Island. 92 (11): 369–71. PMID 19999896.
^"Pathophysiology of Gouty Tophi". The Rheumatologist. Retrieved 2021-07-28.
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January 01, 1970
tophus, tophus, latin, stone, tophi, deposit, monosodium, urate, crystals, people, with, longstanding, high, levels, uric, acid, urate, blood, condition, known, hyperuricemia, tophi, pathognomonic, disease, gout, most, people, with, tophi, have, previous, atta. A tophus Latin stone pl tophi is a deposit of monosodium urate crystals in people with longstanding high levels of uric acid urate in the blood a condition known as hyperuricemia Tophi are pathognomonic for the disease gout Most people with tophi have had previous attacks of acute arthritis eventually leading to the formation of tophi Chronic tophaceous gout is known as Harrison Syndrome 1 Tophus Harrison Syndrome A tophus on the elbow of a middle aged man with chronic gout Tophi form in the joints cartilage bones and other places throughout the body Sometimes tophi break through the skin and appear as white or yellowish white chalky nodules Without treatment tophi may develop on average about ten years after the onset of gout although their first appearance can range from three to forty two years The development of gouty tophi can also limit joint function and cause bone destruction leading to noticeable disabilities especially when gout cannot successfully be treated 2 When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid e g allopurinol febuxostat or increase uric acid elimination from the body through the kidneys e g probenecid this can be referred to as refractory chronic gout RCG 3 They are more apt to appear early in the course of the disease in people who are older Although less common tophi can also form in the kidneys and nasal cartilage Contents 1 Pathophysiology 2 Additional images 3 See also 4 References 5 External linksPathophysiology editIt appears that monosodium urate crystals trigger a distinct physiological NETosis pathway that coats them in DNA These coated crystals then persist in tissues as a foreign body granuloma constituting gouty tophus 4 Additional images edit nbsp Gross pathology of a large tophus nbsp Micrograph of a gouty tophus nbsp A tophus inside a knee joint being removed by arthroscopic surgery nbsp Tophus of uric acid crystals from toe joint fluid 100x polarized light See also editChondrocalcinosis pseudogout References edit Mirgh S P Venkatesh M P 2017 Lumps All over A Case of Chronic Tophaceous Gout Harrison Syndrome Indian Journal of Nephrology 27 3 239 240 doi 10 4103 0971 4065 202842 PMC 5434697 PMID 28553051 Edwards N Lawrence 2008 Gout A Clinical Features Primer on the Rheumatic Diseases New York NY Springer New York pp 241 262 doi 10 1007 978 0 387 68566 3 12 ISBN 978 0 387 35664 8 Retrieved 2021 07 28 Ali S Lally EV November 2009 Treatment failure gout Medicine and Health Rhode Island 92 11 369 71 PMID 19999896 Pathophysiology of Gouty Tophi The Rheumatologist Retrieved 2021 07 28 External links edit nbsp Wikimedia Commons has media related to Tophus Retrieved from https en wikipedia org w index php title Tophus amp oldid 1183834949, wikipedia, wiki, book, books, library,
