This post is an answer to the Case – Painless Swollen Join
Skin biopsy and aspiration of joint fluid excluded calciphylaxis, and confirmed that the patient had urate deposits (tophi)—ie, gout. Microscopy with polarised light showed negatively birefringent urate crystals.
The serum concentration of urate was 530 μmol/L (normal concentration 60–360 μmol/L). Allopurinol was prescribed.
Gout mainly affects men, but this predominance is less pronounced among elderly people—in whom gout usually affects more than one joint, often affects the hand, and tends to develop gradually, with fewer acute attacks than in younger people. Nonetheless, painless gout is rare.
SIMILAR CASE: Patient with Bilateral Tender Fluctuant Masses Over Each Elbow