Gout nodulosis: widespread subcutaneous deposits without gout

Area of Science:

• Rheumatology
• Dermatology
• Metabolic Disorders

Background:

• Gout is a common inflammatory arthritis caused by monosodium urate crystal deposition.
• Clinical manifestations typically include acute, painful arthritis, often affecting the first metatarsophalangeal joint.
• Subcutaneous tophi are usually seen in chronic, untreated gout, often accompanied by joint damage.

Observation:

• A case study of a 35-year-old man with a 6-year history of multiple subcutaneous nodules is presented.
• The patient had no prior history of joint pain or inflammatory arthritis.
• Needle aspiration confirmed the nodules to be monosodium urate deposits.

Findings:

• This presentation represents an unusual initial manifestation of gout, preceding or occurring without articular symptoms.
• A literature review identified 28 similar cases, suggesting a distinct clinical entity.
• The term "gout nodulosis" is proposed to describe this specific presentation.

Implications:

• Recognizing gout nodulosis is crucial for early diagnosis and management of gout, potentially preventing future joint complications.
• This entity expands the spectrum of gout presentations, highlighting the importance of considering urate deposition even in the absence of arthritis.
• Further research is warranted to understand the pathogenesis and long-term outcomes of gout nodulosis.