Arthritis mutilans due to chronic tophaceous gout

Background: Arthritis mutilans is a form of destructive arthritis which is often characterized with severe osteolysis. It is more commonly described in association with the most severe forms of psoriatic and rheumatoid arthritis.Case presentation: A 69-year old man presented with a fifteen-year history of recurrent inflammatory joint pains. Over the years, there has been progressive involvement of more joints until most joints of the upper and lower limbs are symmetrically involved. Examination revealed severe deformities of the hands and feet with gross mutilation of most digits. Several tophi are on the elbows, forearms, most joints of the hands and feet as well as on the palms and soles of the feet. Radiographs of the hands and feet showed several punched out erosions with overhanging edges, osteolysis, subluxations and severe disorganization of the joints. A diagnosis of gout was established with the finding of numerous urate crystals on polarized microscopy of aspirated tophi.Conclusion: This case demonstrates that gout may cause arthritis mutilans. This is however rare and is more likely in a patient with long-standing untreated tophaceous gout.Keywords: Arthritis mutilans, Gout, tophi, Crystal