Chronic gout, which is seen as a sequela of multiple attacks of acute gout, leads to joint destruction and chronic arthritis. Patients with chronic gout may also develop acute episodes of gout. Patients with chronic gout are predisposed to the development of tophaceous gout. This form of gout manifests as skin deposits of urate crystals. It can occur in any location and is most often located within the subcutaneous tissue. These tophi appear clinically as subcutaneous nodules, often overlying the extensor joints, particularly the elbows, Achilles tendons, and hands. For some reason, the ear is another area that is affected by tophi. The nodules of tophi may become thinned and partially translucent. The tophi may show an underlying yellowish appearance beneath the skin, and occasionally the clumping of crystals is appreciated just underneath the skin. With trauma, the nodules occasionally ulcerate, and crystals drain from the tophi. Saturnine gout is a specific form of gout that has been found to be caused by the consumption of homemade moonshine that is contaminated with lead.
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