Gout in the elderly seems to represent a special subgroup. The presentation is often atypical and drug treatment poses special difficulties. We present two elderly patients with large subcutaneous tophi leading to grotesque deformities. Their clinical features, risk factors, diagnosis and treatment are discussed. Although the appearance and radiographic changes caused by tophi are characteristic, the definitive diagnosis of tophaceous gout is made by aspiration and crystal analysis, as is illustrated by colour photographs.
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