This 65 year old gentleman with history of hypertension on hydrochlorothiazide and amlodipine is presenting to you with painful joints.

Question: What’s the diagnosis and how would you treat this?

Answer: This is tophaceous gout! Treatment includes NSAIDs and Colchicine (and intra-articular or rarely PO steroids) in a flare. Recognize that tophi is one of the indications for urate lowering therapy e.g. Allopurinol!