Intraarticular tophi in a joint without a previous gouty attack

Subcutaneous tophi are usually a late clinical manifestation of gout. However, intraarticular tophi may develop very early, since crystal shedding has been presumed to precipitate an acute gouty attack. There is little direct evidence of intraarticular tophi before the initial gouty attack. We describe a patient who had gout for 3 years without subcutaneous tophi. Whitish intraarticular deposits, presumably representing urate tophi, were noted during right knee arthroscopy for a posterior cruciate ligament tear. This observation illustrates that tophi deposition may occur early, even in previously unaffected joints.