Heberden´s Nodes in Women Complicated with Tophi Gout

Gout is currently a very widespread metabolic joint disease. In the course of the long history of gout treatment since Hippocrates the opinion of this disease have changed many times, especially concerning frequency, cause and therapy. Now we are far from thinking that gout occurs only in the “upper class” male population. This article comments the occurens of gout tophi in atypical locations in females, which occur not only on the typical sites, namely 1st metatarsal joint of the foot thumb as a typical for the primary gout. It is also necesary to note that gout currently occurs in females more often than before, including also the tophi gout, which appears not only as primary but also as a secondary gout. It occurs in patiens with chronic renal failure, on the basis of long-term renal disease with longlasting hyperuricaemia. The crystals may settle in a remote damaged hand joint at sites of long lasting osteo-arthritis. This especially applies to Heberden´s nodes (distal interphalangeal joint), mainly on the index fingers. Rarely also can applies to the proximal interphalangeal joint (Bouchard´s nodes). Similar observation has not been found so far in the literature.