My definition of gouty tophi is the same as Tophi, i.e. there is no need to include the word gouty, as all tophi are related to gout.
Gouty Tophi Definition
Tophi is the plural of tophus. A gouty tophus is a deposit of uric acid crystals beneath the skin, attached to joints, and in other organs.
Gouty Tophi Symptoms
I deal with gouty tophi mainly in the Gout Symptoms guidelines. Please note that I often get asked “what is tophi,” but as you have seen, tophi is the plural form, so the question should be either “What are tophi,” or “What is a tophus.”
In the Tophi pages, I present gouty tophi pictures, including photographs and other images. These show gouty tophi affecting various parts of the body.
Gouty Tophi Treatment
Please see the Gout Treatment guidelines for gouty tophi treatment. Get treatment for gout to remove tophi before your joints get destroyed!
I think this is the best tophi picture. Because it shows successful tophi treatment. Most tophi photographs are horrible. But I think you should know the dangers of untreated gout.
Despite the advances in science that mean we can now control gout, there is a tiny minority who cannot tolerate common uric acid-lowering treatment. If you do not get uric acid to safe concentration, you are doomed to the continuous growth of tophi. So, you might treat the pain, but can you control the gout?
Pain relief without uric acid control means more and more uric acid crystals that will eventually show themselves as gouty tophi.
Gouty tophi are usually noticed under the skin, and are not usually painful until they burst through the skin, or become infected.
We tend to ignore them in the early stages, and concentrate more on relieving the pain from acute gout flares.
But is this wise?
Now that technology allows us to see tophi growing into cartilage, tendons, and bones, we can see it is not wise. I’ve added some more important 2014 information to this 2010 article about early detection of joint damage from new gout scanning technology. First let us see how this technology shows early tophi leading to bone erosion and severe, painful, joint damage.
We have seen how gouty tophi grow predominantly beneath the skin. However, they can occur anywhere in the body, and this gout study shows a tophus growing into the finger bone.
This is a layman’s review of a gout patient case report:
Intraosseous tophaceous gout in the proximal phalanx of the small finger.
Oti FE, Reichert B, Bär I.
J Hand Surg Eur Vol. 2012 Sep;37(7):696-7.
Intraosseous tophaceous gout means tophaceous gout that grows into the bone.
Gouty Tophi In Finger Bone Case Report
The doctors report case details of an 88 year old man who had 2 weeks of persistent tenderness and swollen inflammation of the right little finger. It did not respond to (paracetamol), prednisolone, and rest.
The patient had no history of gout, but long history of kidney disease. X-rays revealed nothing, but blood tests revealed 12mg/dL uric acid. Colchicine supported with other pain control failed to give complete relief.
MRI showed a tumor growing into the finger bone. Surgery was performed, as doctors could not be certain that the growth was not cancerous. It was revealed as a tophaceous deposit growing into the bone.
Gouty Tophi In Finger Bone Opinion
Normal first line treatment for tophi is aggressive uric acid lowering. In this case, the true nature of the growth was hard to identify. Tophaceous deposits rarely show on X-ray, and though MRI reveals the growth, it does not identify the exact problem. In this case, surgery was deemed to be the best option to identify and remove the tumor in one operation.
The report highlights:
Tophi grow slowly, and may not trigger a gout attack.
Tophi are not limited to soft tissues.
Tophi are difficult to identify.
Surgery is often the most realistic option for tophi removal
Gouty Tophi In Finger Bone: Next Steps
If you have any unusual growths, which may or may not be accompanied by swelling, gout is suspected if no obvious alternative is revealed by X-ray.
Immediate treatment by very low uric acid might be available, otherwise you can expect surgery.
Tophi are lumps of uric acid crystals. Tophi are the plural of tophus, meaning stone. They start as small jelly-like lumps under gout patients skin. Left untreated, they grow and harden forming disfiguring tumors. Eventually, tophi can burst the skin and destroy joints. They also damage kidneys, heart and other organs. See why you have to stop tophi before gout destroys your body.
The tophi pages feature pictures of the worst effects of gout. Actually, these visually shocking images featuring shocking pictures of disfiguring gouty tophi only tell part of the story. Tophi usually refers to large deposits of uric acid crystals under the skin. Because those crystals form lumps that move when pushed. Other deposits nearer the bone, especially in joints are often more dangerous. I have written about the dangers of uric acid crystals in and around the joints several times. You can find these by searching for bone erosion or joint destruction in the search box at the top of each page.
Tophi, though unsightly, do not usually cause significant pain unless they restrict mobility near a joint, or burst through the skin. This second phenomenon can cause other problems if the resulting wound becomes infected.
Tophi can be removed by surgery. Also, they will shrink if uric acid is maintained at safe levels. The safe level is often recognized as 6mg/dL (0.36mmol/L). However, 5mg/dL is a better target, as this allows for a suitable safety level. Several months at a much lower level is the fastest way to shrink tophi without surgery.
The pages below refer to tophi in different parts of the body, often with tophi pictures which some gout sufferers may find upsetting as they display the most grotesque symptoms of gout. In the Gout Treatment section, I explain ways you can remove tophi. You might also be interested in my early review of Why Tophi Are Important To Gout Sufferers.
There you are, crying in agony, and I ask stupid questions! But is it really stupid?
For most gout sufferers, pain relief is our primary goal. The more sensible will seek permanent control of gout through safe uric acid management. That stops pain returning, but takes a few months. In the middle of a gout attack, all we want to do is stop the pain.
In fact, I discussed this at length when I wrote about finding freedom from gout pain. That is a formula for getting rid of gout pain, and I am expanding the principles in my Stop Gout service. You will be able to generate your own personal gout treatment plan to get rid of gout pain in a way that suits you.
But, getting rid of gout pain does not get rid gout. Treating pain alone, just leaves more uric acid crystals growing all round your body, slowly destroying your joints and damaging your organs. In between attacks, you have painless gout. With practice, you can learn to block gout pain as soon as you feel the first twinge. In fact, some gout patients take preventative pain relief. They experience painless gout, but as well as failing to stop serious damage from uric acid crystals, they risk serious illness from longterm pain relief drugs.
Finger tophi don’t always hurt, but they do stop you gripping. Even painless tophi make life difficult when your fingers are affected.
These finger tophi photographs show what happens when tophaceous gout hits your fingers.
Like toes and ears, fingers are subject to lower temperatures, so these extremities are common targets for tophi. A tophus, the singular of tophi, can form in any soft tissue when you have gout. This page covers gout in and around the finger joints.
Tophi In The Index Finger
It is difficult to say if this is a grouping of several tophi, or a single tophus. It doesn’t really matter, if you have several lumps or one big one, you can be certain that you need to get treatment fast. Early uric acid lowering treatment at maximum dose will ensure that tophi shrink as fast as possible. This can often avoid lancing or other surgical procedures, and dose can be relaxed after a year or so to maintain uric acid at a safe level of 5mg/dL (0.30 mmol/L).
I cannot imagine how difficult it must be to perform everyday tasks with tophi on the fingers. I have experienced swollen joints in my wrist, fingers, and hand, and I know how difficult that made life for me. Best to get your acute gout fixed before it gets tophaceous, so head over to the Gout Treatment department and get your uric acid safe.