Finger pad tophi in a patient with Raynaud phenomenon

MSU: monosodium urate ULT: urate-lowering therapy INTRODUCTION The natural history of gout includes 4 progressive stages (asymptomatic hyperuricemia, acute arthritic attacks, intercritical gout, and chronic gouty arthritis). Asymptomatic hyperuricemia is characterized by elevated serum urate. Deposition of monosodium urate (MSU) crystals in articular and periarticular tissues then instigates acute arthritic attacks. Intercritical gout eventually results in chronic gouty arthritis with no pain-free intervals. Tophi, MSU crystal aggregates, are primarily associated with chronic gout. Common locations for tophus development include the helix of the ear, olecranon bursa, hands, knees, feet, and fingers. There are few reports of tophaceous deposits on the fingertips. Finger pad tophi have been reported in individuals without prior acute gouty arthritis. Finger pad tophi represent a dermatologic presenting feature of gout and an indication for prompt initiation of urate-lowering therapy (ULT) to prevent sequelae of chronic hyperuricemia. We describe a case of finger pad tophi in the context of chronic Raynaud phenomenon and suggest a potential role for the Raynaud phenomenon in the process of tophus formation.