Abstract:
Gout is one of the most prevalent inflammatory arthritides and is
frequently associated with chronic kidney disease (CKD), metabolic syndrome, and
cardiovascular comorbidities. Long-standing hyperuricemia and poor adherence to
urate-lowering therapy contribute to the development of severe disease manifestations,
including tophi formation, urate nephropathy, and progressive renal dysfunction.
We present a clinical case of a 62-year-old man with a 20-year history of gout
complicated by extensive tophaceous deposits, stage G4 chronic kidney disease, urate
nephrolithiasis, metabolic syndrome, dyslipidemia, and hepatic steatosis. Clinical
examination revealed multiple tophi involving the auricles, hands, feet, Achilles tendons,
and large joints, accompanied by joint deformities and functional impairment.
Laboratory findings demonstrated persistent hyperuricemia, inflammatory activity,
anemia, impaired renal function, and metabolic abnormalities. Imaging studies
confirmed characteristic erosive joint lesions, osteoporosis, nephrolithiasis, and fatty
liver disease.
A comprehensive treatment strategy including febuxostat, low-dose colchicine, renin–
angiotensin system blockade, ketoanalogue supplementation, lipid-lowering therapy, and
lifestyle modification was implemented. The case highlights the clinical consequences of
inadequate long-term control of hyperuricemia and emphasizes the importance of early
diagnosis, strict adherence to urate-lowering therapy, and multidisciplinary management
involving both rheumatologists and nephrologists.
