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a deposit of urates around a joint or in the external ear; diagnostic of advanced or chronic gout (同)chalkstone

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/19 01:48:45」(JST)

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A tophus (Latin: "stone", plural tophi) is a deposit of monosodium urate crystals in people with longstanding high levels of uric acid in the blood. 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.

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.^[1] 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 or RCG.^[2] They are more apt to appear early in the course of the disease in people who are older in age.

Although less common, tophi can also form in the kidneys and nasal cartilage.

A tophus inside a knee joint being removed by arthroscopic surgery.

Additional images[edit]

Micrograph of a gouty tophus.

References[edit]

^ Edwards, N. Lawrence (2008). Primer on the Rheumatic Diseases: Chaper 12: Gout A. Clinical Features. Springer. pp. 241–248.
^ Ali, S; Lally, EV (November 2009). "Treatment failure gout.". Medicine and health, Rhode Island 92 (11): 369–71. PMID 19999896. Cite uses deprecated parameters (help)

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1. 痛風の臨床症状および診断 clinical manifestations and diagnosis of gout
2. 痛風性関節炎の病態生理 pathophysiology of gouty arthritis
3. 皮膚の良性病変の概要 overview of benign lesions of the skin
4. 痛風再発の予防 prevention of recurrent gout
5. 無症候性高尿酸血症 asymptomatic hyperuricemia

English Journal

Febuxostat: A Review of Its Use in the Treatment of Hyperuricaemia in Patients with Gout.

Frampton JE1.
Drugs.Drugs.2015 Feb 28. [Epub ahead of print]
Febuxostat (Adenuric®, Uloric®, Feburic®) is an orally-active, potent, non-purine, selective xanthine oxidase inhibitor. In the EU, it is indicated in adults for the treatment of chronic hyperuricaemia in conditions where urate deposition has already occurred. Unlike allopurinol, the prototypical
PMID 25724536

Role of miR-146a in regulation of the acute inflammatory response to monosodium urate crystals.

Dalbeth N1, Pool B1, Shaw OM2, Harper JL2, Tan P1, Franklin C1, House ME1, Cornish J1, Naot D1.
Annals of the rheumatic diseases.Ann Rheum Dis.2015 Feb 2. pii: annrheumdis-2014-205409. doi: 10.1136/annrheumdis-2014-205409. [Epub ahead of print]
OBJECTIVES: MicroRNAs (miRNA) are small non-coding RNAs that function as post-transcriptional repressors of gene expression. We hypothesised that miRNA regulate gene expression of proinflammatory cytokines in response to monosodium urate (MSU) crystals.METHODS: We stimulated human monocytic THP-1 ce
PMID 25646371

Imaging as an Outcome Measure in Gout Studies: Report from the OMERACT Gout Working Group.

Grainger R1, Dalbeth N1, Keen H1, Durcan L1, Edwards NL1, Perez-Ruiz F1, Diaz-Torne C1, Singh JA1, Khanna D1, Simon LS1, Taylor WJ1.
The Journal of rheumatology.J Rheumatol.2015 Feb 1. pii: jrheum.141164. [Epub ahead of print]
OBJECTIVE: The gout working group at the Outcome Measures in Rheumatology (OMERACT) 12 meeting in 2014 aimed to determine which imaging modalities show the most promise for use as measurement instruments for outcomes in studies of people with chronic gout and to identify the key foci for future rese
PMID 25641895