Corresponding author: Hiroshi Shiba, hshiba0124@gmail.com
DOI: 10.31662/jmaj.2025-0357
Received: July 23, 2025
Accepted: August 29, 2025
Advance Publication: November 21, 2025
Published: January 15, 2026
Cite this article as:
Shiba H, Asano T, Okada M. Chronic Gouty Dactylitis. JMA J. 2026;9(1):393-394.
Key words: gout, dactylitis, monosodium urate crystal
A 57-year-old man with a ten-year history of untreated gout presented with acute right ankle pain. Physical examination revealed multiple tophi involving the joints and subcutaneous tissues of his limbs, non-tender diffuse swelling of the fourth digit of his left hand, and arthritis of the right ankle (Figure 1A). Laboratory findings confirmed hyperuricemia and elevated inflammatory markers, including a C-reactive protein level of 4.2 mg/dL (reference, 0.0-0.3). X-rays of his hands showed erosions and a soft-tissue mass in the left fourth finger (Figure 1B). A diagnosis of an acute gout flare was established. The patient was treated with nonsteroidal anti-inflammatory drugs.
In long-standing uncontrolled gout, monosodium urate crystals can deposit around tendons and phalanges, manifesting as chronic dactylitis (1), (2). The reported prevalence of dactylitis in gout is low, ranging from 5% to 10% (1). The presence of chronic dactylitis may suggest severe disease, with more tophi and involved joints, higher serum uric acid concentrations, and longer disease duration (2).
Data acquisition and manuscript drafting: Hiroshi Shiba. Manuscript review and supervision: Takahiro Asano, and Masato Okada.
None
We have obtained informed consent for this manuscript.
In this study, IRB approval was not required.
Forbess LJ, Fields TR. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum. 2012;42(2):146-54.
Hamard A, Burns R, Miquel A, et al. Dactylitis: a pictorial review of key symptoms. Diagn Interv Imaging. 2020;101(4):193-207.
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