Rheumatology

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Tophaceous gout: an unusual cause of multiple fractures
Scandinavian Journal of Rheumatology , 10/16/09

Nguyen C et al. – Monosodium urate (MSU) crystals can contribute to bone lesions by reducing osteoblastic activity and are associated with enhanced osteoclast activity in the vicinity of tophi. Mild trauma triggers MSU crystal release from tophi, resulting in cell activation and production of cytokines and proteases. This could enhance bone erosion leading ultimately to bone fragility and fracture. Our cases exemplify a rare cause of spontaneous fracture. Gouty tophus should be considered when facing a lytic lesion with fracture.

• PubMed search conducted to identify the relevant literature

• 13 patients analysed
• 11 cases of tophaceous fracture reported since 1950
• Common features are: known and long-standing gout with tophi; minor or absence of trauma; specific locations include 7 patients with patella bone fractures
• Other sites include cervical spine in 2 patients, the first and fifth metatarsal, and phalanx in 1patient each, the ilium and pubic bones in 1, the medial malleola, and the femoral neck in latter case

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