Tophaceous gout of the knee: successful treatment with transarterial microembolization.

Abstract

Gout is an inflammatory arthritis caused by monosodium urate crystal deposition, often resulting in joint pain and impaired function. While pharmacologic treatments are usually effective, some patients with persistent inflammation and hypervascular tophi may experience suboptimal responses, necessitating alternative approaches. We present the case of a 63-year-old male with chronic right knee pain due to tophaceous gout that was unresponsive to standard medical therapy. Imaging demonstrated calcified tophi with associated hypervascularity in the knee joint. Transarterial microembolization (TAME) using imipenem/cilastatin (IPM/CS) was performed, targeting abnormal vascular blushes identified on angiography. The patient reported significant pain relief shortly after the procedure. Subsequently, febuxostat with prophylactic colchicine was initiated as urate-lowering therapy. This case illustrates the feasibility of TAME as a potential adjunctive treatment in selected patients with refractory tophaceous gout. Additionally, pre-procedural imaging, such as contrast-enhanced magnetic resonance imaging (MRI), may help identify patients who are more likely to benefit from TAME.