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      Diagnosis and Treatment of Patellar Tendon Gouty Tophus: A Case Report

      , MD 1 , , FRCS Tr&Orth 1 , , FRCS Tr&Orth 1

      The Surgery Journal

      Thieme Medical Publishers

      gout, patellar tendon, tophaceous, deposits, treatment

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          Abstract

          The main aim of this case report is to thoroughly describe the steps of diagnosis and treatment in the rare incidence of patellar tendon gouty tophus. The case of a 53-year-old man manual worker who was treated with open excision of the lesion, following failure of extended medical treatment with rheumatological input, is presented. Surgical treatment led to full restoration of the patient's knee function. Open or arthroscopic surgery is a viable option for the unusual case of intratendinous patellar gouty deposition if the patient fails medical management. Medical treatment should still be the mainstay.

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          Most cited references 19

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          Epidemiology of gout.

          Gout is the most prevalent inflammatory arthritis in men. The findings of several epidemiologic studies from a diverse range of countries suggest that the prevalence of gout has risen over the past few decades. Although incidence data are scarce, data from the United States suggests that the incidence of gout is also rising. Evidence from prospective epidemiologic studies has confirmed dietary factors (animal purines, alcohol, and fructose), obesity, the metabolic syndrome, hypertension, diuretic use, and chronic kidney disease as clinically relevant risk factors for hyperuricemia and gout. Low-fat dairy products, coffee, and vitamin C seem to have a protective effect.
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            Tendon involvement in the feet of patients with gout: a dual-energy CT study.

            To examine the frequency and patterns of monosodium urate (MSU) crystal deposition in tendons and ligaments in patients with gout using dual-energy CT (DECT). Ninety-two patients with tophaceous gout had DECT scanning of both feet. Two readers scored the DECT scans for MSU crystal deposition at 20 tendon/ligament sites and 42 bone sites (total 1840 tendon/ligament sites and 3864 bone sites). MSU crystal deposition was observed by both readers in 199/1840 (10.8%) tendon/ligament sites and in 399/3864 (10.3%) bone sites (p=0.60). The Achilles tendon was the most commonly involved tendon/ligament site (39.1% of all Achilles tendons), followed by the peroneal tendons (18.1%). Tibialis anterior and the extensor tendons were involved less commonly (7.6-10.3%), and the other flexor tendons, plantar fascia and deltoid ligaments were rarely involved (<5%) (p<0.0001 between sites). Involvement of the enthesis alone was more common in the Achilles tendon (OR (95% CI) 74.5 (4.4 to 1264), p<0.0001), as was any involvement of the enthesis (OR (95% CI) 6.8 (3.6 to 13.0), p<0.0001). Tendons are commonly affected by MSU crystal deposition in patients with tophaceous gout. The patterns of MSU crystal deposition suggest that biomechanical strain or other local factors may contribute to deposition of MSU crystals.
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              Risk factors for gout and prevention: a systematic review of the literature.

              Our objective was to perform a systematic review of risk factors and prevention of gout. We searched Medline for fully published reports in English using keywords including but not limited to 'gout', 'epidemiology', 'primary prevention', 'secondary prevention', 'risk factors'. Data from relevant articles meeting inclusion criteria were extracted using standardized forms. Of the 751 titles and abstracts, 53 studies met the criteria and were included in the review. Several risk factors were studied. Alcohol consumption increased the risk of incident gout, especially beer and hard liquor. Several dietary factors increased the risk of incident gout, including meat intake, seafood intake, sugar sweetened soft drinks, and consumption of foods high in fructose. Diary intake, folate intake, and coffee consumption were each associated with a lower risk of incident gout and in some cases a lower rate of gout flares. Thiazide and loop diuretics were associated with higher risk of incident gout and higher rate of gout flares. Hypertension, renal insufficiency, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, diabetes, obesity, and early menopause were each associated with a higher risk of incident gout and/or gout flares. Several dietary risk factors for incident gout and gout flares are modifiable. Prevention and optimal management of comorbidities are likely to decreased risk of gout. Research in preventive strategies for the treatment of gout is needed.
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                Author and article information

                Journal
                Surg J (N Y)
                Surg J (N Y)
                10.1055/s-00028781
                The Surgery Journal
                Thieme Medical Publishers (333 Seventh Avenue, New York, NY 10001, USA. )
                2378-5128
                2378-5136
                April 2019
                18 June 2019
                : 5
                : 2
                : e46-e49
                Affiliations
                [1 ]Department of Sports Knee Surgery, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
                Author notes
                Address for correspondence Theodoros Bouras, MD Department of Sports Knee, The Robert Jones and Agnes Hunt Orthopaedic Hospital Oswestry SY10 7AGUnited Kingdom theo_bouras@ 123456hotmail.com t.bouras@ 123456nhs.net
                Article
                1900010cr
                10.1055/s-0039-1692675
                6581534

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funding
                Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
                Categories
                Case Report

                treatment, deposits, tophaceous, patellar tendon, gout

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