A 79-year-old man presented to the clinic with pain, severe deformities and functional impotence in his hands and feet (Fig. 1A and B). At the age of 59 he had a first episode of knee arthritis, diagnosed as gout after finding uric acid at 9 mg/dl and a tophus in his third left hand finger. He was treated with colchicine and allopurinol with benefit. For arterial hypertension he was also prescribed beta-blockers and hydrochlorothiazide. In later years, knee arthritis recurred 3 to 4 times a year requiring arthrocentesis and colchicine therapy.
