Gout Pain

Gout pain comes from inflammation - an immune system response to uric acid crystals.

But it gets worse.

The uric acid crystals build up to form deposits called tophi. Though these are not painful in themselves, tophi can impair joint movement, and burst through the skin, causing more pain.

And worse still.

We now know that tophi can grow inside your bones, leading to bone erosion and severe, painful, joint damage.

Historically, it has always been difficult to measure tophi, as they do not show up on X-ray images. Lack of measurement makes it difficult to assess how gout can damage bones. Joint damage is common in long-term gout sufferers. Until recently, the reason has been unclear.

Now, a new report from N Dalbeth, et al, Mechanisms of bone erosion in gout; a quantitative analysis using plain radiography and computed tomography, (published in ARD) shows how tophi grow inside bone, causing damage.

The aim of this study was to understand the mechanisms of bone erosion in gout using non-invasive imaging techniques.

Alternative techniques would involve surgical procedures to examine tophus growth directly - hardly an acceptable choice. Though the study does nothing to help reduce gout pain, it does underline the importance of acting on tophi as soon as they are noticed. The report concludes:

There is a strong relationship between bone erosion and the presence of intraosseous tophus. These results strongly implicate tophus infiltration into bone as the dominant mechanism for development of bone erosion and joint damage in gout.

Tophi are normally noticed first as jelly-like lumps, that gradually become harder as more uric acid crystals (urate) accumulate. It is vital that you get urate lowering therapy immediately. Even if these tophi are painless now, in time they will bring more agony as your bones crumble.

Consult your rheumatologist about urate lowering therapies. Discuss this, and all aspects of gout pain in the gout forum.