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April 1992

Tophi as the Initial Manifestation of Gout: Report of Six Cases and Review of the Literature

Author Affiliations

From the Providence Medical Center (Drs Wernick and Winkler), Division of Rheumatology, The Oregon Health Sciences University (Dr Wernick), and Division of Rheumatology, Veterans Affairs Medical Center (Dr Campbell), Portland, Ore.

Arch Intern Med. 1992;152(4):873-876. doi:10.1001/archinte.1992.00400160155032

The development of tophi in the absence of prior episodes of gouty arthritis is unusual. We present six such cases and review 26 previously published cases. These patients differ from those with typical gout in that they were older, more likely to be women, and usually had predominant or exclusive finger involvement. Most had renal insufficiency and many were receiving an anti-inflammatory or diuretic. Although several possibilities for the lack of gouty arthritis in the presence of tophi exist, usually no clear explanation is found.

(Arch Intern Med. 1992;152:873-876)