A New Form of Arthritis Mutilans Related to Successful Gout Treatment

82 years old woman with a history of severe nodal hand osteoarthritis affecting both fingers and thumb base. She also had hypertension and chronic renal failure and in 1992 she started getting attacks of gout. Attempts to treat her with allopurinol had to be stopped due to side effects. Her hands became progressively affected by tophaceous gout with chronic pain particularly in the DIP joints. In 2012 she started febuxostat 80mg daily. Her symptoms improved within weeks and serum uric acid levels changed from 712 μmol/l in 2012 to 89 μmol/l in 2014. Tophy at other sites, including a large olecranon tophus regressed and have now disappeared (Figure 1).