This patient was diagnosed with gout approximately 20 years ago. At that time, he noted the gradual onset of pain in the left knee, followed by swelling, redness and heat, all of which persisted for approximately one month. Shortly thereafter, he He has had periodic numerous episodes of hot, painful, swollen joints involving the left knee, left ankle, and both first metatarsophalangeal joints. At the time of this time admission the patient was hospitalized for evaluation of these arthritides. Serum had increased serum uric acid values on three separate occasions were 8.0, 9.3, and 8.7 mg/dl. In addition to the presence of the his painful swollen joints, a gouty tophus was also present on the left arm. The patient was readmitted to the hospital from time to time because After remission of his acute exacerbations of gouty arthritis. On gout flare-up the most recent hospital admission, a 3-cm tophus was found over the right elbow, as well as several smaller tophi over the right handsurgically removed.

== Autopsy Findings ==The surgical specimen consisted of an elliptically shaped, mottled, yellow-white irregular hard mass, measuring 8.0 x 5.0 x 2.0 cm. in diameter.

* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the specific enzyme defect is unknownbut there is some enzyme abnormality which leads to hyperuricemia and symptoms of gout. In rare cases the specific enzyme defect is known, but gout symptomatology is the main clinical finding.