Gout - some extreme pictures

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

It will take quite some time to mobilize the uric acid deposits as pegloticase isn't appoved in Germany.

07.09.2015
Here is another X-ray chart about the destruction, gout tophi may cause. At some places the bone has gone completely.