Gouty Knee Arthritis

A 57-year-old man with a long-standing history of gout and non-standard medication for 15 years, and habits of smoking and drinking for 40 years was admitted to our hospital. His discomfort included recurrent and progressive acute pain and motion limit of the knees. The physical examination revealed mildly red, swelling, and tender knees with reduced ROM (range of motion) of -20° to 60° (extension to flexion). Classic tophuses were found on both first metatarsal-phalangeal joint. Laboratory and radiographic tests revealed hyperuricemia (890 μmol/l, normal range 120-420 μmol/l), monosodium urate crystals, and degenerative joint features. The patient received a diagnosis of gouty knee arthritis, which is an indication for total knee arthroplasty. During the surgery, extensive tophi, white lime-like sediment of urine acid crystals, were discovered covering the articular facets of femur and tibia. The patient successfully discharged from the hospital with advice of lifestyle improvement and standard medication of gout suppressant.