Dear Bingley: I had forgotten about the skin involvement.
From the Internet:
"Although gouty arthritis can affect almost any joint, the first (great) toe is the most common; other commonly affected joints include joints in the foot, ankle and knee. Sometimes a lump of uric-acid crystals (called a tophus) forms in or near the joint or in other tissues, such as the skin. Risk factors for the development of tophi include advanced age, diuretic medications (water pills), kidney disease and many past episodes of gouty arthritis. The most common sites of tophi are the outside of the ear, the Achilles tendon, and the elbow."