Frequency of Tophi in True Gouty Arthritis Underestimated
In reviewing the statistics of authors as to the frequency of the incidence of tophi in their cases of assumed gouty arthritis I am inclined to think their relative infrequency is apparent rather than real, in other words that many of their cases of alleged “gouty” arthritis which lack tophi would, if investigated by modern methods, have been shown to be due to other causes of arthritis, this especially as regards their assumed cases of chronic gout. For who can doubt that prior to the discovery of X-rays many cases of osteoarthritis, etc., were thus erroneously labelled? Nor indeed, as we hope to show later, is it improbable that similar fallacies obtained even in regard to acute types of gout, particularly when of polyarticular distribution.
It will be noted that we confine our criticisms to those examples of “gouty” arthritis unassociated with tophi. But if, as we maintain, our scepticism be justifiable, then it follows that it diminishes to an unknown extent the percentage of cases of genuine “gouty” or uratic arthritis which lack tophi.