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Case Reports in Medicine
Volume 2011, Article ID 397646, 3 pages
http://dx.doi.org/10.1155/2011/397646
Case Report

Tophaceous Gout and Renal Insufficiency: A New Solution for an Old Therapeutic Dilemma

1Section of Rheumatology, Department of Internal Medicine, University Clinic “Carl Gustav Carus” of the Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
2Department of Cardiology and Intensive Care, Heart Centre Dresden, University Hospital of the Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany

Received 24 February 2011; Accepted 12 March 2011

Academic Editor: P. E. Schwarz

Copyright © 2011 Anne-Kathrin Tausche et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The prevalence of gout is increasing with increased life expectancy. Approximately half of the patients with gout have some degree of renal impairment. If both conditions persistently coexist, and in severe tophaceous gout, in particular, treatment has been difficult. We here report on the case of an 87-year-old woman, who had been suffering from recurrent gouty arthritis over 4 years. Monthly polyarthritis attacks were accompanied by subcutaneous tophi. Serum uric acid levels were constantly above 600 μmol/L (10 mg/dL). Allopurinol was no option because of intolerance, while benzbromarone was ineffective because of renal impairment. Therefore, the novel xanthin oxidase inhibitor febuxostat was started, achieving rapid control of serum urate levels (<360 μmol/L). After initial worsening of inflammation in the first weeks, gouty attacks stopped and all tophi resolved within the following 10 months. Renal function remained stable.