Disabling gout.

摘要

A 62-year-old man was referred for assessment of continuous pain in his left foot that left him unable to do his work as a driver. He had had gout affecting his big toe for 6 years. This was accompanied by a sustained rise in serum uric acid (to more than 480 umol/L; normal range <390 umol/L). Clinical examination showed a hallux valgus (figure A); walking was accompanied by exercise pain, and he had abnormal gait. A radiograph of his foot showed severe destruction of the first metatarsal bone (figure B). Subsequent MRI showed a large gouty tophus (figure C). A large lobular tophus was excised during subsequent surgery (figure D). Histological analysis of the excised material showed a mass of crystals surrounded by a wall of inflammatory cells (figure E), and birefringent needles that were typical of monosodium urate crystals were seen on polarised light microscopy (figure F). The microscopy findings confirmed our diagnosis of destructive gout. After arthrodesis, our patient's pain disappeared. He is currently taking daily allopurinol and has not had any clinical relapses.