This young patient has painful swelling in hands and knees from four years. He has chronic hyperuricemia which is poorly controlled despite treatment. Diagnosis of gout had been made by joint aspirate. He is also suffering from hypertension which started around the same time as gout. He denies a family history of similar condition.

He is on allopurinol and colchicine for gout and amlodipine for hypertension. The rheumatologist is considering starting him on pegloticase.

Gout is a crystal deposition disease caused by deposition of monosodium urate crystals mainly in the joints. The crystals can also be deposited in tendons and nerves. The first metatarsal-phalangeal joint is the classic site of involvement. Knees are occasionally involved but hand involvement is uncommon.

The diagnosis can be made by visualization of negative birefringent crystals in the joint aspirate.