Authors:

Adam Kamel

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About Paper:

Gout is a chronic metabolic disease characterized by acute, painful episodes and chronic tophaceous deposits. Although urate-lowering medications, like allopurinol and febuxostat, are mainstays for managing the chronic aspect of this condition, more curative treatment modalities may be desired. In this review, we aim to synthesize the existing literature on outpatient procedures utilized in managing gout. We conducted a systematic search of multiple databases using search terms relevant to gout, dermatology, and outpatient procedures. Of the 1312 studies identified in this search, 10 were included for extraction via screening by two independent reviewers using the Covidence software. 32 patients were included in these 10 studies, with an average age of 66.7 (+- 17.6) and 68.8% (n=22) being male. The most common comorbidities were hypertension (9.4%), diabetes mellitus (6.3%), and dyslipidemia (6.3%). The majority of patients concurrently managed with medications, with allopurinol (78.1%) and colchicine (18.8%) being most common. Of outpatient procedures performed, surgical excision was the most common (68.8%), followed by curettage/sharp debridement (18.8%) and platelet-rich plasma (PRP) injection (6.3%). Outcomes differed across procedure types. PRP-based therapies were associated with complete healing in all treated patients (n=2, 100%). Curettage and sharp debridement resulted in complete healing or lesion resolution in 83.3% of patients (n=5), while cosmetic satisfaction without a defined clinical endpoint was reported in 16.7% (n=1). Surgical excision most frequently produced partial improvement (n=20, 90.9%), with complete healing observed in 4.5% (n=1). This review preliminarily highlights the potential for partial to complete improvement through a variety of outpatient procedures. Our study was limited by its small sample size and variation in outpatient procedures performed. Future studies should evaluate the efficacy of outpatient procedures compared to medical management.

Source:

University of Chicago

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Co-authors:

Adam Kamel