Clinical Report: Involvement of Tendons and Ligaments in Gout

Background

Gout is a prevalent form of arthritis characterized by the deposition of monosodium urate crystals, primarily affecting joints but also involving tendons and ligaments. Tendon injuries, such as ruptures, can lead to significant functional limitations and are increasingly recognized in patients with advanced gout. Understanding these complications is crucial for effective management and prevention strategies. [Citation needed]

Data Highlights

The patient was a 68-year-old man with a history of poorly controlled tophaceous gout. MRI findings included:

• Bilateral Achilles tendon ruptures identified approximately 6 to 6.5 cm proximal to the calcaneal insertion.
• Gap measurements: 4.5 cm on the left and 2 cm on the right.
• Serum urate level at presentation was 9.6 mg/dL.

Key Findings

• The patient had a history of poorly controlled tophaceous gout with serum urate levels above 9 mg/dL.
• Acute tendon rupture occurred after a short course of levofloxacin treatment.
• MRI revealed extensive intratendinous tophaceous deposits in multiple tendons.
• Positive Thompson test bilaterally indicated suspicion for Achilles tendon rupture.
• Conservative management was favored due to the extensive tophaceous burden and chronic tendon changes.

Clinical Implications

This case underscores the importance of monitoring tendon health in patients with advanced gout, especially those receiving fluoroquinolone antibiotics. Clinicians should consider the potential for tendon injuries in this population and adjust management strategies accordingly.

Related Resources & Content

1. Frontiers in Immunology, 2026 -- Study on the pro-inflammatory injury of neutrophil extracellular traps in gouty nephropathy
2. Frontiers in Medicine, 2026 -- Correlation analysis of metabolic parameters influencing postoperative tendon healing after Achilles tendon rupture repair
3. Archives of Orthopaedic and Trauma Surgery, 2026 -- Rerupture after flexor tendon repair of the hand and wrist: a retrospective risk factor analysis
4. 2020 American College of Rheumatology Guideline for the Management of Gout
5. Recommendations | Gout: diagnosis and management | Guidance | NICE
6. Frontiers in Immunology — Neutrophil extracellular traps in gout: from immune defense to pathological dynamic equilibrium
7. A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture)
8. Time-course of tophus resolution on Dual-energy CT and ultrasound after 24months of a treat-to-target strategy
9. 2020 American College of Rheumatology Guideline for the Management of Gout
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11. OP0177 PROPERTIES AND LOCATIONS OF COLOR-CODED DUAL ENERGY CT LESIONS IN GOUT PATIENTS – A SYSTEMATIC EVALUATION - ScienceDirect
12. Hyperuricemia May Increase Risk of Achilles Tendon Rupture: A Case Control Study - PubMed
13. Gouty Tophi Surrounding the Nonabsorbable Sutures of an Achilles Tendon Repair Surgical Site: A Case Report - PubMed