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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 gout flare-up the tophus was surgically removed. The surgical specimen consisted of gouty arthritis. On the most recent hospital admissionan elliptically shaped, mottled, a 3yellow-white irregular hard mass, measuring 8.0 x 5.0 x 2.0 cm tophus was found over the right elbow, as well as several smaller tophi over the right hand. in diameter.