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Answer 1
  1. Tophus of the elbow. Gout is caused by the cumulative effects of hyperuricemia. As the total body load of uric acid increases, the vast majority of patients progress through 3 stages: asymptomatic hyperuricemia, acute intermittent gout, and chronic tophaceous gout. In rare cases, patients present with tophi without having experienced any significant joint pain. Treatment of gout depends on its stage of progression. In patients with asymptomatic hyperuricemia and acute intermittent gout (occurring fewer than 3 times per year), long-term management consists of modification of risk factors (ie, avoidance of diuretics and alcohol, weight loss, and avoidance of dehydration). These measures may all reduce gout attacks by lowering uric acid levels. Indications for uric acid­lowering therapy include tophaceous gout, frequent attacks (3 or more per year), and urate nephropathy.

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