Recently we treated a patient with gout. Let me first thank this gentleman for agreeing to publish his x-ray charts and pictures of his hands.
He had been pretreated in an outside hospital. So, the uric acid already had been lowered from about 13.8 to 8.0 mg/dl. ESG and CRP were only slightly elevated.
The x-ray charts show multiple joint involvement and tophi destroying bones
In the pictures one can see the uric acid deposits under the skin and swelling of joints
Here is another X-ray chart about the destruction, gout tophi may cause. At some places the bone has gone completely.