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Clinical treatment for gouty tophi

Discussion in 'General Issues and Discussion Forum' started by Richie, Aug 16, 2010.

  1. Richie

    Richie Member

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    I have a patient with a really bad gouty toe, I understand the pharmacological interventions available however does any one have suggestions for the best clinical interventions.
  2. posalafin

    posalafin Active Member

    Have the patient to modify any known risk factors for gout & pharmacological treatment is the clinical treatment for gout.
  3. posalafin

    posalafin Active Member

    If the crystals remain & continue to cause pain long term (after the acute inflammation has resolved) sometimes the crystals are surgically removed. If a wound develops as much of the tophi that can be removed from the wound should be during debridement & dressing.
  4. footsiegirl

    footsiegirl Active Member

    hmm..not sure they can do this if it is the diuretics that has caused it though...?:rolleyes:
  5. G Flanagan

    G Flanagan Active Member

    give them a DMI. good for short term relief whilst your trying to work out best medical therapy.

    If its end stange degeneration, surgical opinion.


  6. posalafin

    posalafin Active Member

    Depends why they are on the diuretics. If the diuretics have been prescribed for hypertension,which they frequently are, then an alternative hypertensive regime can be instituted. It is also unlikely that diuretics would be the only risk factor so if it was absolutely necessary for the patient to remain on diuretics there would most likely be other modifiable risk factors.
  7. footsiegirl

    footsiegirl Active Member

    I was merely playing devil's advocate - sorry!
  8. krome

    krome Active Member


    A bad gouty toe....sounds like chonic gout? Is it discharging? Assume it is not, then via his/her GP or rheumatologist the patient should be on a high-dose drug such as Allopurinol (100mg or 300mg). Allopurinol decreases both uric acid formation and purine synthesis.

    From a podiatric perspective, good advice on footwear to ensure that the enlarged, inflammed joint is not irritated by the shoe. Footwear modification may also be needed.
  9. David Singleton

    David Singleton Active Member

    Just wondering what DMI stands for could you explain?

    Cheers Dave
  10. G Flanagan

    G Flanagan Active Member

    of course Dave,

    depo-medrone injection.

    ps sorry i missed your last clinic the other day. Good luck!
  11. David Singleton

    David Singleton Active Member

    Cheers George,

    No worries! Nice wheels by the way!
  12. dsfeet

    dsfeet Active Member

    I've had some good results when treating ulcers associated with gout tophi, by using
    salie wash .........though way back in 96 a paper at that conference suggested weak bi-carbonate,
    dressing is iodosorb and lyofoam , dry 4 + days then repeat till healed
    worth a try
  13. Fraoch

    Fraoch Active Member

    We currently have a 97 year old with several gouty tophi outcrops + associated wounds. Things have improved immensely since we convinced the GP to change her meds. Short term pain relief has been best with 2 x per week ultrasound in water bath. Managing wounds by debriding as much as possible. Not yet tried Iodosorb on that but will give it a go.
  14. mayoo

    mayoo Member

    Pharmaceutical intervention such as allopurinol for chronic and colchicine for acute episodes. Diet management is obviously important.

    For tx of the tophi in an open lesion, iodosorb can be good but solugel and other topical medicaments that can autolytically debride is often better. It is often less painful than mechanical debridement also. If persistent a surgical refferal could be sought.
  15. Fraoch

    Fraoch Active Member

    Sorry if this is a stupid question but what should I expect from a surgical referral? What kind of treatment?
    Over the years my gout pts have received naff all from their rheumatologist and GPs other than allopur and colch. My experience is sthat urgeons will not touch these pts as "there is no point, it'll just flare up again anyway".
    If you have a different experience I would like to hear your pts outcome.
  16. krome

    krome Active Member


    A review of the literature states the opposite. There are many case reports which describe different surgical options. I suggest you google or use PubMed to identify them and then show them to your surgeons. However, surgery is always the final option; excellent non-surgical intervention that includes pharmacological internvetion and good podiatric advice for specific foot problems should always be considered as the first option.

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