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crystals and low-grade inflammation can persist in the joint during this period.23 Once an initial acute gout attack has occurred, further attacks are likely to follow. Recurrent attacks of acute gout often lead to chronic tophaceous gout, in which monosodium urate deposits (tophi) form in the soft tissues, usually along the rim of the ear, over the elbow joint, and in the joints of the fingers and toes. Tophi reduce the growth and viability of bone cells (osteoblasts),24 and if left untreated, tophaceous gout can lead to significant joint erosion and loss of function.22
