The tophus is a characteristic and pathognomonic sign of chronic gout.
Before effective drugs were available for the treatment of hyperurica
emia about 50-60% of patients with gout developed clinically and radio
logically apparent urate crystal deposits. Clinical cutaneous manifest
ations of chronic gout are now rarely observed. However, the presence
of degenerative tissues, as in idiopathic osteoarthritis of the finger
s, may predispose to the deposition of urate crystals. We report on a
patient with secondary - probably diuretic-induced - hyperuricaemia an
d gout tophi in Heberden's nodes.