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Gout

A Rare Case of Ulcerated Tophaceous Gout

Patients with tophaceous gout rarely develop ulcers, but when they do, these ulcers can be difficult to treat. This case report reviews the care and outcome of a patient with tophaceous ulcers.
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Gout

Patients with tophaceous gout rarely develop ulcers, but when they do occur, these ulcers can be difficult to treat. This case study explores the diagnosis of and treatment options for patients with ulcerated tophaceous gout.

Diagnosing gout can be vexing. Most of the time, the diagnosis is made in the primary care setting where physicians diagnose gout by following one of six classification criteria, with the most widely used one being the 1977 American Rheumatism Association criteria.

Four trials of moderate-quality evidence found no significant improvement in pain control in acute gout with NSAIDs vs COX inhibitors. But there was evidence that patients stopped NSAIDs early because of adverse events.

Gout attacks really do occur more often at night, and here is proof. Theories abound as to why, but effective prophylactic treatments to reduce the risk of nocturnal exacerbations appear to be just what the doctor ordered.

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For key facts and figures about musculoskeletal disorders, perhaps a surprise as the fourth leading diagnostic category in primary care, see the pages that follow.

Courtesy Angela Potter, MD

A large population study shows that people with gout may have a reduced risk of dementia -– including Alzheimer’s disease. This is a significant finding and may support theories that uric acid has antioxidant properties and possible neuroprotective effects.

Courtesy Ayeh M. Abeles, MD and Michael H. Pillinger, MD

Effective treatment for gout management does exist, but without patient compliance, gout exacerbations continue to be common. Here: strategies to get buy-in from the patient.

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