Tophi: periarticular deposits

A tophus is an organised tissue deposit of monosodium urate crystals. It reflects chronic crystal deposition.

Inspect hands, feet and other sites of nodules; assess consistency, mobility, pain and function. Look for skin breakdown.

The source documents tophaceous gout. The panel shows finger and great-toe swellings, with pale areas beneath the skin.

Previous joint attacks and hyperuricaemia support the interpretation. Crystal identification in a sample provides confirmation when needed.

Rheumatoid nodules, calcinosis and osteoarthritic nodes may enter the differential. Location, consistency and context matter more than colour alone.

Assess mobility, skin damage and renal or cardiovascular comorbidity. Establish treatment and flare history rather than inferring them from the photograph.

A very painful joint with fever or a draining lesion requires assessment for infection, even in someone with established gout.

Serum urate alone does not identify a nodule. The photograph does not establish current activity or adequacy of disease control.

Combine the deposit pattern, joint history and appropriate confirmation; consider infection when a lesion is inflamed.

• NICE NG219 — Gout: diagnosis and management (2022) ↗
• Arthritis Research UK Primary Care Centre, Keele University (E. Roddy) — document iconographique original / original image ↗

Documentary review: 2026-10-16