A Missed Opportunity: Tophaceous Gout

CGazitt et al represent a missed opportunity case to diagnosis chronic tophaceous gout. Several features of one patient's case belied the original diagnosis. A 70-year-old Filipino man presented to the clinic, complaining of sub- acute worsening of chronic hand pain. Two weeks prior, he experienced increasing pain and swelling of the meta-carpophalangeal joints and both wrists. Over the past several years, he had similar episodes, each lasting 2-3 weeks; shorter when he received oral nonsteroidal anti-inflammatory drugs or prednisone. Between these periods, minimal joint swelling and stiffness remained. Nevertheless, over time, he noted progressive deformity of his meta-carpophalangeal joints. In addition, he reported occasional pain during use of the left shoulder and both knees. He denied fever, chills, rash, or neurologic problems. He had a history of hypertension, chronic renal insufficiency, and remote heavy alcohol use. His only medications were naproxen and acetaminophen.