Discussion Author: Rick Riego de Dios
Tophaceous gout manifests in patients with established disease. It involves deposition of urate, protein matrix, inflammatory cells and giant cells in soft tissues. The deposits can occur in tendons, ligaments, cartilage, bone and other soft tissue. There is a tendency for deposits to occur in the following areas: olecranon bursa and cartilage of the ear, nose and menisci. Osteolysis may occur with soft tissue deposits. Nodules contain monosodium urate crystals. The subcutaneous tophaceous deposits may be the initial manifestation of gout. Gout nodulosis describes a subset of patients without arthritis who develop tophi in soft tissues.
The common locations in the hand and wrist include the following in order of decreasing frequency: DIP joints, IP joints and MCP joints.
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