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Gout: HELP
Articles from Portugal
Based on 18 articles published since 2008
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These are the 18 published articles about Gout that originated from Portugal during 2008-2019.
 
+ Citations + Abstracts
1 Guideline 2016 updated EULAR evidence-based recommendations for the management of gout. 2017

Richette, P / Doherty, M / Pascual, E / Barskova, V / Becce, F / Castañeda-Sanabria, J / Coyfish, M / Guillo, S / Jansen, T L / Janssens, H / Lioté, F / Mallen, C / Nuki, G / Perez-Ruiz, F / Pimentao, J / Punzi, L / Pywell, T / So, A / Tausche, A K / Uhlig, T / Zavada, J / Zhang, W / Tubach, F / Bardin, T. ·AP-HP, hôpital Lariboisière, service de Rhumatologie, F-75010 Paris, France; Inserm, UMR1132, Hôpital Lariboisière, F-75010 Paris, France; Universitè Paris Diderot, Sorbonne Paris Citè, F-75205 Paris, France. · Academic Rheumatology, University of Nottingham, Nottingham, UK. · Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain. · Institute of Rheumatology RAMS, Moscow, Russia. · Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland. · AP-HP, Dèpartement d'Epidèmiologie et Recherche Clinique, Hôpital Bichat, Paris, France: APHP, Centre de Pharmacoèpidèmiologie, Paris, France: Univ Paris Diderot, Paris, France: INSERM UMR 1123 ECEVE, Paris, France. · Patient from Nottingham, UK, Paris. · Department of Rheumatology, VieCuri Medical Centre, Venlo, and Scientific IQ HealthCare, Radboud UMC, Nijmegen, The Netherlands. · Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands. · Arthritis Research UK Primary Care Centre University of Keele, Keele, UK. · Osteoarticular Research Group, University of Edinburgh, Edinburgh, UK. · Seccion de Rheumatologia, Hospital de Cruces, Baracaldo, Spain. · Rheumatology Unit, Clínica Coração de Jesus, Lisbon, Portugal. · Rheumatology Unit, University of Padova, Padova, Italy. · Service de Rhumatologie, CHUV and Universitè de Lausanne, Lausanne, Switzerland. · Department of Rheumatology, University Clinic at the Technical University Dresden, Germany. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Czech Republic. ·Ann Rheum Dis · Pubmed #27457514.

ABSTRACT: BACKGROUND: New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations. METHODS: The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach. RESULTS: Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended. CONCLUSIONS: These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.

2 Review Outcomes assessed in trials of gout and accordance with OMERACT-proposed domains: a systematic literature review. 2015

Araújo, Filipe / Cordeiro, Inês / Ramiro, Sofia / Falzon, Louise / Branco, Jaime C / Buchbinder, Rachelle. ·Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia flipar@msn.com. · Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia. · Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia. ·Rheumatology (Oxford) · Pubmed #25398382.

ABSTRACT: OBJECTIVE: The aim of this study was to systematically review outcome domains and measurement tools used in gout trials and their accordance with the preliminary OMERACT gout recommendations published in 2005. METHODS: Randomized controlled trials (RCTs) and quasi-RCTs investigating any intervention for gout published up to February 2013 were included. Recruitment start dates and all measured outcomes were extracted. Risk of bias (RoB) was assessed with the Cochrane Collaboration tool. Numbers of OMERACT domains were compared for trials at low vs unclear/high RoB and for recruitment start date before 2005 or 2005 and later. RESULTS: Of 9784 articles screened, 38 acute and 30 chronic gout trials were included. Mean (s.d.) number of OMERACT outcomes was 2.9 (1.1) (out of 5) and 2.5 (1.2) (out of 9) for acute and chronic gout trials, respectively. Health-related quality of life, participation and joint damage imaging were not assessed in any trial. Tools used to measure individual domains varied widely. There were no differences in the number of OMERACT outcomes reported in acute or chronic gout trials recruiting before 2005 vs 2005 or later [mean (s.d.): 3.0 (1.1) vs 3.5 (1.3), P = 0.859 and 2.7 (1.1) vs 2.8 (1.4), P = 0.960, respectively]. While both acute and chronic trials at low RoB reported more OMERACT domains than trials at unclear/high RoB, these differences were not significant. Industry-funded trials and trials performed by OMERACT investigators reported more OMERACT outcome domains. CONCLUSION: We found no appreciable impact of the OMERACT recommendations for gout trials to date.

3 Review Tophaceous gout of the spine: case report and review of the literature. 2012

Marinho, Frederic / Zeitoun-Eiss, Delphine / Renoux, Jerôme / Brasseur, Jean-Louis / Genestie, Catherine / Grenier, Philippe. ·Department of medical imaging, Hospital Central do Funchal, Avenida Luis de Camoes, Funchal 9000-054, Portugal. fredericmarinho@yahoo.fr ·J Neuroradiol · Pubmed #21652076.

ABSTRACT: Tophaceous gout of the spine is rare. We report here the case of a 68-year-old man with long-standing peripheral gouty arthritis who developed a progressive and painful weakness of the lower extremities. Radiological and histopathological findings confirmed the presence of tophaceous gout of the spine. Also presented is the case history, including the radiological and histopathological findings, and a discussion of the literature.

4 Review [Current management of gout]. 2011

Miguel, Cláudia / Mediavilla, Maria Jesús. ·Instituto Português de Reumatologia, Lisboa, Portugal. ·Acta Med Port · Pubmed #22525631.

ABSTRACT: Gout, one of the most prevalent rheumatic diseases in the world, results from deposition of uric acid crystals in several locations, particularly in joints, subcutaneous tissues and kidney. The classical treatments, although effective, are often poorly tolerated or contraindicated. Recently, new drugs have emerged for the treatment of hyperuricemia and gout, including febuxostat and uricase, which proved to be quite promising. Some drugs already used in other diseases, such as losartan, atorvastatin, fenofibrate and amlodipine also seem to have a role in monitoring the serum uric acid. This article reviews the pathophysiology, clinical management and current therapeutic options for Hyperuricemia and Gout.

5 Article Tophaceous gout of the lumbar spine mimicking a spinal meningioma. 2018

Ribeiro da Cunha, Pedro / Peliz, António Judice / Barbosa, Marcos. ·Neurosurgery Department, Coimbra University Hospital Center, Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. pedrorcferreira@gmail.com. · Neurosurgery Department, Coimbra University Hospital Center, Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. ·Eur Spine J · Pubmed #27817138.

ABSTRACT: PURPOSE: Although gout is a common metabolic disorder, it usually affects distal joints of the appendicular skeleton. Axial spine involvement is rare, with only 131 cases reported in the literature. The authors report a rare case of lumbar spinal gout mimicking a spinal meningioma. METHODS: A 77-year-old man with a history of gout presented with chronic low back pain and progressive paraparesis. Imaging revealed a lumbar spine compressive mass lesion with a dural tail signal. The differential diagnosis was thought to be straightforward favoring a spinal meningioma. Tophaceous gout was never considered. The presence of a dural tail associated with the lesion is an interesting detail of this case, that strongly misguided it and to the best of our knowledge it is the first one reported in the literature. RESULTS: The patient underwent surgery and intra-operative findings were surprisingly different from those expected, revealing a chalky white mass lesion firmly adherent and compressing the dural sac. It was completely excised, leaving the dura intact. Histopathology confirmed the diagnosis of tophaceous gout. The patient was sent to physical therapy and had a complete remission of pain and neurological deficit, regaining his walking capacity. CONCLUSION: Although spinal gout is rare, it should be considered in the differential diagnosis for patients presenting with symptoms of spinal stenosis, a suspicion of neoplastic lesion of the spine, and a previous history of gout. Early diagnosis can ensure proper and timely medical management, perhaps avoiding neurological compromise and the need for surgery.

6 Article Bone scintigraphy in tophaceous gout. 2016

Fernandes, Ana / Faria, Maria Teresa / Oliveira, Ana / Vieira, Tiago / Pereira, Jorge. ·Nuclear Medicine Department, Serviço de Medicina Nuclear, Centro Hospitalar São João, Av. Hernâni Monteiro, 4200, Porto, Portugal. anaritaclemts@hotmail.com. · Nuclear Medicine Department, Serviço de Medicina Nuclear, Centro Hospitalar São João, Av. Hernâni Monteiro, 4200, Porto, Portugal. ·Eur J Nucl Med Mol Imaging · Pubmed #26936853.

ABSTRACT: -- No abstract --

7 Article Identifying Patient Candidates for IL-1 Inhibition: Lessons From Real-World Cases. 2015

Avram, Annalina / Duarte, Cátia / Santos, Maria José / Papagoras, Charalampos / Ritis, Konstantinos / Scarpioni, Roberto / Schmidt, Wolfgang A / Skendros, Panagiotis. ·Medical Doctor; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin - Buch, Berlin, Germany. · Rheumatologist, Rheumatology Department, Centro Hospitalar, Universitario de Coimbra, Coimbra, Portugal. · Medical Doctor, Department of Rheumatology, Hospital Garcia de 'Orta, Lisbon, Portugal; University Hospital of Alexandroupolis, Alexandroupolis, Greece. · Rheumatologist, First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. · Professor of Internal Medicine, First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. · Head, Department of Nephrology and Dialysis, Ospedale AUSL "Guglielmo da Saliceto", Piacenza, Italy. · Deputy Director, Immanuel Krankenhause Berline Medical Centre for Rheumatology Berlin - Buch, Berlin, Germany. Electronic address: w.schmidt@immanuel.de. · Assistant Professor of Internal Medicine, First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. ·Joint Bone Spine · Pubmed #26717798.

ABSTRACT: A subgroup of patients with gouty arthritis have a chronic recurring form that is particularly difficult to treat. Such patients experience repeated flares and often have abundant tophi. Many also have underlying comorbidities, such as renal impairment, cardiovascular disease, gastrointestinal disorders, obesity, and hypertension, which contraindicate the use of standard anti-inflammatory medications. Five patients with difficult to treat gouty arthritis who were either candidates and/or treated with anti-IL therapy are described.

8 Article [Chronic tophaceous gout]. 2014

Spínola, Adelaide / Caldeira, Mónica / Dias, Graça. ·Serviço de Medicina Interna. Hospital Central do Funchal. Funchal. Portugal. ·Acta Med Port · Pubmed #25641299.

ABSTRACT: -- No abstract --

9 Article Whitish nodules on the fingers. 2014

Bonifácio, Eliana / Rocha, Ana Manuela / Silva, Joana / Morais, Paulo. ·MD, Family Medicine Trainee, USF Santa Joana, Aveiro, Portugal. ·Aust Fam Physician · Pubmed #25393467.

ABSTRACT: -- No abstract --

10 Article [Septic arthritis and gout--a case report]. 2012

Serra, S / Monteiro, P / Vaz, A / Pires, E / Monteiro, R / Inês, L / Salvador, M J / Bernardo, J / Malcata, A. ·Serviço de Reumatologia, Hospitais da Universidade de Coimbra, Portugal. saramserra@hotmail.com ·Acta Reumatol Port · Pubmed #22781515.

ABSTRACT: The authors describe a 54 year-old male patient, admitted after presenting in the emergency room with acute oligoarthritis affecting the shoulders and right tibiotarsal and sternoclavicular joints, with a week's duration. He was non-febrile and related a purulent discharge from the stump of a traumatic amputation of the left thumb, starting a few days prior to the presenting complaints. There was a previous history of gouty arthritis and moderate alcoholism. Lab work revealed an elevation of the acute phase markers, with marked neutrophilia. Upon admittance, the patient underwent arthrocentesis, revealing a purulent discharge with sodium monourate crystals, which cultured positively for meticillin-sensitive Staphylococcus aureus. Besides antibiotherapy, on Day 5 the patient presented with a cervical abscess with extension to mediastinum; the abscess was drained by a cardiothoracic surgeon, and the right sternoclavicular and first costochondral articulations were found to be destroyed. The authors note that, although it is a rare occurrence septic arthritis can coexist with gout, while discussing the possible mecanisms of this association, as well as particular details of the clinical case presented.

11 Article Multiple arthritis: three in one. 2012

Henriques, Celia Coelho / Lourenço, Filipa / Lopéz, Begoña / Panarra, António / Riso, Nuno. ·Department of Internal Medicine 2, Curry Cabral Hospital, Lisbon, Lisbon, Portugal. celia.c.henriques@gmail.com ·BMJ Case Rep · Pubmed #22605592.

ABSTRACT: -- No abstract --

12 Article Juvenile gout: rare and aggressive. 2012

Henriques, Celia Coelho / Monteiro, Agostinho / Lopéz, Begoña / Sequeira, Luís / Panarra, António / Riso, Nuno. ·Department of Internal Medicine 2, Curry Cabral Hospital, Lisbon, Portugal. celia.c.henriques@gmail.com ·BMJ Case Rep · Pubmed #22602839.

ABSTRACT: -- No abstract --

13 Article [Intraosseous gouty tophus - the occult reality...]. 2011

Sá, D / Barcelos, A. ·Interna do Internato Complementar de Medicina Interna do Hospital Infante D. Pedro, Aveiro, Portugal. dulcidia.1978@gmail.com ·Acta Reumatol Port · Pubmed #21483287.

ABSTRACT: -- No abstract --

14 Article [Chronic tophaceous arthropathy and leprosy in the same patient]. 2010

Teixeira, Filipa / Ribeiro, Ana / Bogas, M / Afonso, Carmo / Araújo, Domingos. ·Serviço Reumatologia, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal. filipadteixeira@gmail.com ·Acta Reumatol Port · Pubmed #21245823.

ABSTRACT: -- No abstract --

15 Article Compliance in gout patients. 2010

Silva, L / Miguel, Eugenio De / Peiteado, Diana / Villalba, Alejandro / Mola, Martin / Pinto, Josã / Ventura, Francisco S. ·Rheumatology Department, Hospital de São João, Universidade do Porto, Portugal. ligia1silva@yahoo.com ·Acta Reumatol Port · Pubmed #21245815.

ABSTRACT: INTRODUCTION: Despite its relative high prevalence,potential devastating clinical consequences and socio-economic impact, the existence of effective drugs to treat it, and the well recognised direct relation between acute flares and treatment interruptions and its resumption, gout is still often considered the chronic disease with the worst rate of adherence to therapy. The reason for this is unknown. We proposed to thoroughly evaluate a subgroup of patients, aiming at identifying the clinical features predictive of non-compliance, and 5 different ways to assess those. METHODS: We analysed a number of clinical, analytical and ultrasound data relating to 34 gout patients (according to the Wallace-ARA diagnostic criteria for gout 1977 and the EULAR recommendations for gout diagnosis 2006), which were followed in a specialized rheumatology consultation as part of an ongoing study for ultrasound validation in gout. To assess non-compliance, we compared the prevalence of each one of these clinical features with 5 outcomes (2 of which related to "non-compliance": self-report of non-adherence to therapy and missing consultation, and 3 other outcomes related to "non-response": gout flare(s), final serum uric acid (sUA) ≥ 6 mg/dL, and no sonographic improvement) registered during a 1 year of follow-up assessment. RESULTS: We have found an association between younger age, higher body mass index, previous treatment with urate lowering drugs, self-report of previous non-compliance, nephrolithiasis and hyperuricosuria and the "outcomes of non-compliance". These patients tended to be less often treated with NSAID and allopurinol, and more often treated with corticosteroid and benzbromarone during the 1 year follow-up. They have also presented higher rate of gout flares and final sUA. Evaluating the 3 "outcomes of non-response", we have noticed a tendency for association with long disease duration, self-report of previous non-compliance (frequently attributed to gout flare), higher initial sUA and kidney failure. These patients tended to be less often treated with NSAID, and more often treated with allopurinol. Gout flare correlated to self-report of non-compliance and no sonographic improvement. Sonographic non response also correlated to higher final sUA. CONCLUSIONS: This study shows an association between some clinical features and non-compliance, but above all, and unlike the majority of other studies, it has found a correlation between non-compliance with possible causes of worst response or lower rate of treatment, such as hyperuricosuria, nephrolithiasis, kidney failure, and contraindication for NSAID treatment. The data which is based on a comprehensive and detailed clinical assessment, might point out hidden elements, which might go beyond the visible non-compliance, contributing to the frequent lack of control of the disease.

16 Article [Gout tophi with an atypical location in a patient with multiple septic gout tophi]. 2010

Coutinho, Margarida / Barcelos, A. ·Interna de Reumatologia, Serviço de Reumatologia dos Hospitais da Universidade de Coimbra, Coimbra. margarida.coutinho@portugalmail.pt ·Acta Reumatol Port · Pubmed #20711102.

ABSTRACT: -- No abstract --

17 Article [Rasburicase for tophaceus gout treatment]. 2009

Ribeiro, Ana / Bogas, Mónica / Costa, José / Costa, Lúcia / Araújo, Domingos. ·Interna Complementar de Reumatologia, Serviço Reumatologia, Unidade Local de Saúde do Alto Minho, Ponte de Lima. anaroxo79@iol.pt ·Acta Reumatol Port · Pubmed #19820680.

ABSTRACT: The main obstacle to the treatment of hyperuricemia in patients with allergy to allopurinol is the limited availability of equally efficient alternative drugs. The authors present a clinical case of a patient with incapacitant tophaceus gout, allergy to allopurinol and contraindication for uricosurics, who was treated with rasburicase, an urato-oxidase recombinant, based on experience with this drug in tumoral lisis and in some cases reports of tophaceus gout. The authors also enhance the fact of being a patient with a sequelar hemiplegia of a previous cerebrovascular disease that presents tophus only in the not paretic member. The management of patients with allergy to allopurinol can be a clinical challenge, and the monthly rasburicase perfusions may be an alternative treatment of serious gout not treatable for other ways.

18 Article Whitish bullae on the fingers: what is the diagnosis? Tophaceous gout. 2009

Nogueira, Ana / Duarte, Ana F / Morais, Paulo / Magina, Sofia / Azevedo, Filomena. ·Department of Dermatology and Venereology, Hospital S. João, EPE, Porto, Portugal. anacatu@hotmail.com ·Dermatol Online J · Pubmed #19723483.

ABSTRACT: A 56-year-old woman presented with a 6 month history of bullae and whitish plaques of the fingers. She had chronic renal failure, but no joint pains or evidence of arthritis. An aspirate of fluid from a bulla revealed uric acid crystals and serum uric acid was elevated at 16.2 mg/dL. A diagnosis of tophaceous gout was made.