Chronic Tophaceous Gout Presenting With Severe Polyarticular Erosive Disease: A Case Report

TL;DR

A 63-year-old man with chronic tophaceous gout showed severe joint damage and was treated with corticosteroids, colchicine, and febuxostat.

Contribution

This case highlights the importance of clinical history and imaging in managing severe tophaceous gout despite normal uric acid levels.

Findings

The patient had extensive joint erosions and deformities despite a serum uric acid level within the reference range.

Radiographs revealed hand erosions, hook-shaped osteophytes, and bilateral knee damage.

Treatment with corticosteroids, colchicine, and febuxostat led to clinical improvement.

Abstract

Gout is an inflammatory disease caused by deposits of monosodium urate crystals in joints, bone, and surrounding soft tissues. It can present as acute gout flares, chronic gouty arthritis, and tophaceous gout. A 63-year-old man with long-standing hyperuricemia and tophaceous gout, intermittent adherence to therapy, and alcohol use presented with polyarticular pain and swelling during hospitalization for an infected venous leg ulcer. Physical examination showed multiple tophi and deformities of the metacarpophalangeal and interphalangeal joints, spontaneous drainage of white material from the right elbow, and swollen knees with exudation from the left knee. Serum uric acid was 4.6 mg/dL (reference range 3.4-7.0). Radiographs demonstrated hand erosions and hook-shaped osteophytes. The right elbow had punched-out erosions with periarticular soft-tissue densification and bilateral gonarthrosis with fibular-head erosions. He was treated with corticosteroids, colchicine, and febuxostat, with clinical improvement, and remains under outpatient follow-up. Tophaceous gout can lead to extensive joint and soft-tissue destruction despite normal serum-urate levels; clinical history and imaging are essential to assess disease burden and guide management.

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