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Gout is a common systemic metabolic disease caused either by increased uric acid production or by decreased uric acid excretion potentially leading to crystal deposition of monosodium urate in various tissues and resulting in acute gouty attacks mainly initially presenting as mono arthritis of joints. The further course can be accompanied with development of chronic tophaceous gout with or without complications such as skin perforation of tophi accompanied with occurrence of chronic fistula anddoi:10.15226/2475-4676/3/3/00144 fatcat:wim2667lzzhhdnf4fry7srjxce