ACR Image Competition 2021 Results, Part 3

A 27-year-old man was referred to us for joint pain and nodular swelling over multiple joints. His symptoms started when he was 13 years old, but he was sub-optimally treated.

On examination, we found marked digital deformity, with multiple large tophi over the small joints of his hands, elbows, knees and both feet.

Hand radiographs revealed large erosions and osteolysis over the second metacarpophalangeal joints of both hands, multiple soft tissue tophi and punched-out juxta-articular erosions of other small joints. A diagnosis of erosive polyarticular tophaceous gout was made.

The patient was treated with colchicine and allopurinol, and education was provided.

Wendy Wan Hui Lee, MD, MRCP(UK), is an internist and rheumatology fellow at Sarawak General Hospital, Kuching, Malaysia.