Tophaceous deposition in the finger pads without gouty arthritis

Robert H. Shmerling, Beth Israel Hospital
Steven H. Stern, Brigham and Women's Hospital
Ellen M. Gravallese, University of Massachusetts Medical School
Fred G. Kantrowitz, Beth Israel Hospital

At the time of publication, Ellen Gravallese was not yet affiliated with the University of Massachusetts Medical School

Abstract

Tophi are rarely observed in patients without a prior history of gouty arthritis. We describe four patients whose initial manifestation of gout was tophaceous deposition in an unusual location, the finger pad. None of these patients had a history of acute gouty arthritis and none had tophi elsewhere. All four patients were postmenopausal women with decreased renal function; all were taking diuretics. We conclude that tophaceous gout without arthritis may be more common than previously recognized and that tophi may deposit in the finger pad. We recommend prompt aspiration and crystal analysis of white subcutaneous finger pad deposits in hyperuricemic patients even without a history of gouty arthritis.