The image below is of the distal interphalangeal (DIP) joint of a 76-year-old man with a diagnosis of gouty arthritis and tophi. The affected finger is erythematous and tender, with chalky subcutaneous deposits. DIP articulations are a common location for gouty tophi. This was a second acute attack of gout in 5 years; the patient was not taking any medication to maintain appropriate serum urate levels.
