Tophi Photographs

Why are tophi important to gout sufferers?

Why are tophi important? Gout sufferers care about the severe pain of gout attacks, but a single tophus is usually painless. So, what exactly are tophi, and why are they so dangerous to gout sufferers?

Tophi is the plural of tophus. A single small tophus is easy to miss, but they grow and clump together, forming large lumps of many tophi. They are not usually painful until they burst skin. Eventually, they grow worse, destroying joints and damaging organs. You must not ignore these lumps, so read on to see how to stop tophi.

The form of gout when this particular gout symptom occurs is also known as tophaceous gout.

What are tophi?

Tophi Photographs
Click photo for more details, or see the tophi guidelines.
A Tophus (from the Latin for stone) is a deposit of crystallized uric acid normally found just under the skin. Commonly, they occur on the ear, any finger and toes and around the ankle and elbow. When small they are not always obvious, but appear as movable lumps. When they grow larger they can be seen as whitish nodules that can become painful, particularly if they are near enough to a joint to restrict movement. They usually occur around 10 years after the onset of gout, but can occur earlier, particularly for older people.

Are tophi serious?

When they first start to form they are barely noticeable and not usually taken seriously. Compared to the pain of an arthritic attack of a joint by uric acid crystals, they seem harmless. They should not be ignored. In the worst case, left untreated, they will grow as more uric acid crystallizes around the lump. Eventually they will become disfiguring as well as painful as they cause, in extreme cases, destruction of bone and cartilage. In the best case, they are a source of uric acid that can be re-dissolved back into the blood system. This will raise uric acid concentration and increase the chance of further gout attacks in the joints.

Research into gout pain based on CT scanning technology shows that bone erosion begins much sooner than first thought. As soon as uric acid crystal deposits start to build up, a new tophus can often grow into the bone, causing bone damage and crippling pain.

What can I do?

Reducing uric acid levels in your blood will gradually cause tophi to dissolve. You should consult your doctor to discuss medical treatments available. The medications section describes many of the drugs available, and it will be useful for you to study these before you discuss your medication with your doctor.

There are alternative remedies that may suit you, and many of these are listed in the prevention section.

You should also consider planning your diet to reduce uric acid levels.

Share Your Tophi Experience

Tophi are a strong indication that your gout is serious, and hasn’t been managed very well so far. I’m trying to campaign for better gout treatment so that gout patients do not have to suffer the disfiguring and painful experience of tophaceous gout.

Find more tophi information in the Tophi Guidelines

This page, first published before 2008, is republished as part of ongoing website maintenance. Please see the Gout Symptoms Section for latest articles on recognizing tophi, the Gout Treatment Section for latest articles on treating tophaceous gout, and the Uric Acid Section for understanding how a tophus forms.

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