The Tophus That Damages Hand Joint in a Female Patient Diagnosed with Premenopausal Gout: A Case Report

Gout is a disease cauising severe and sudden pain, tenderness, rash, edema and temperature rise in the joints. Although it appears generally in males, it can also be seen especially in postmenopausal women and it can rise in the joints except toe joint. It should be kept in mind for differential diagnosis and clinical approach in chronic hand arthritis. Sixty-one years old female patient admitted to our clinic with swelling and pain in the right second finger existing for several months. She had hypertension and was on 5 mg/day amlodipin and she was diagnosed with gout 9 years ago and was on colchicine 1 mg/day, allopruinol 300 mg/day. There were gray color changing, swelling, movement restriction and pain on 2. distal interphalengeal joint. Body mass index of the patient was 38 kg/m2. Blood analyses values were normal and uric acid level was detected 6.2 mg/dL (normal 4.2-5.4 mg/dL). There were subchondral osteopenia, severe intraarticular narrowing and degenerative changes at X-ray examination. The medical treatment of patient was planned and she was consulted for surgery to orthopedics clinic. Uric acid crystals cumulate in joints and their environment in chronic gout patients. These accumulations are called tophus when they get together abundantly. They occur under the skin as swelling. Tophuses generally located at affected joints and their environment, on fingers, on elbows or external ear. Tophuses can damage joints. Although it appears generally in males, it can also be seen especially in postmenopausal obese women and it can rise in the joints except toe joint. It should be kept in mind for clinical approach, treatments and preventing unnecessary surgeries chronic gout arthritis