Gout is a prototypic example of crystal-induced arthritis and is responsible for about 2%-5% of chronic joint diseases. It is characterized by transient bouts of acute arthritis caused by deposition of monosodium urate crystals in and around joints. The underlying metabolic abnormality is hyperuricemia (plasma urate levels > 6.8 mg/dl) that results from either overproduction or decreased excretion of uric acid. The image shows chronic tophaceous gout involving small joints of hands bilaterally. Several large gouty tophi accompanied by crippling deformities of the involved joints can be seen. Advanced cases such as this are uncommonly seen in the developed countries due to the progress in the diagnosis and treatment of the disease.