Tophaceous Gout is a serious stage of gouty arthritis. There is a strong indication that either you have avoided medical attention, or the advice you have received is completely flawed. You must seek rapid, maximum lowering uric acid treatment (within the bounds of safety). This will shrink tophi over several months, but if this is not soon enough, you may need surgery. See the tophaceous gout guidelines for more tophi information.
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.
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.
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.
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.
Swollen joints or tophaceous gout is the fourth step in the I Have Gout program. Earlier, we created an extended list of personal signs of gout with expectations about our diagnosis. Then, in the previous step, we listed all our symptoms of gout. Now we need to list all joints that are affected with those symptoms, including any parts of the body affected by unexplained lumps.
People often think that gout only affects the big toe. Nothing is further from the truth. Gout can affect any joint. It normally starts with those joints that are most exposed to cold. This is usually the big toe, but your lifestyle or your job can influence this. My ankle was affected first, which I put down to a lot of driving, where the ankle is often most exposed to cold, and it is usually the lowest center of gravity.
This page covers the fourth step in my Personal Symptoms Assessment and Diagnosis Plan for gout sufferers called I Have Gout. It is a 7 step program for creating your own personal gout symptoms plan, and links to all steps are at the end of this swollen joints explanation.
Signs Of Gout
End Acute Gout and More
Your Symptoms Of Gout
Is It Swollen Joints Or Tophaceous Gout?
Uric Acid Test To Start
Gout Diagnosis At Last
Ignorance Causes Gout
Gout will eventually spread to all joints. However, it is unusual in the early years of gout for it to effect more than two joints at a time. The most likely explanation for this is when crystals form, the uric acid they contain is no longer dissolved in the blood stream. Once a certain quantity of uric acid passes from solution into crystals, no more new crystals form, so joints stop being affected. Many gout sufferers, including myself, have noticed a sensation of “moving gout.” For example, gout starts in the knee, followed by the elbow, followed by the ankle, etc. This is a series of gout attacks in different joints. There is no way of knowing which joint will get attacked next.
What Are Your Swollen Joints?
Though the most common symptom of gout is painful swelling, remember from the previous step, that redness, numbness, itching, etc may also be present. When you study your joints for symptoms of gout, please list all joints affected by each gout symptom.
Finally, uric acid crystals are not restricted to joints – they can form anywhere. As well as listing swollen joints, you should also list any unexplained lumps. These could be tophi, and when we get to the next step, your doctor may want to test for tophaceous gout.
Tophaceous gout is the name applied to a stage of gout where uric acid crystals form jelly-like clumps under the skin. Without treatment, the crystals, together with dead white blood cells, will continue to grow and harden.
Tophaceous Gout: Causes
Uric acid crystals tend to form slowly. In many people, this means that they do not get the excruciating painful gout flare that results from the immune system being overwhelmed by an invasion of crystals. Instead, the isolated crystals are engulfed by white blood cells, and are no longer seen as a threat. This is similar to the process used by our immune system to defeat invading bacteria and viruses. In those cases, the invaders disintegrate after attack by white blood cells, and the resulting debris is absorbed or excreted.
As uric acid crystals are not living cells, they cannot die, but the coating from white blood cells renders them invisible to the immune system. They are no longer a threat, but they have to go somewhere. They either eat into your cartilage, tendons, and bone, destroying joints, or they form lumps in soft tissue giving tophaceous gout.
Tophaceous Gout: Symptoms
The lumps are collectively called tophi, with a single lump being a tophus. As well as the disfiguring appearance, tophi can restrict movement, and may burst through the skin causing pain and risking infection in the resulting wound. If lumps are opened, either by accidental trauma, or deliberate lancing, they usually exude a chalky substance that looks like toothpaste.
As uric acid crystals form more readily at colder temperatures, tophi are usually found in the extremities, particularly the ears, fingers and toes. However, they can grow anywhere, so it is important to get unknown growths checked by your doctor as soon as possible.
Tophaceous Gout: Diagnosis
Diagnosis is straightforward, and reflects the standard for diagnosing gout in general. The test is to analyze a sample from a tophus under polarizing microscope which will reveal uric acid crystals if gout is present.
There are new imaging technologies that can reveal uric acid crystals in the body without the invasive sampling processes. DECT is the best of these, but availability is very limited. Ultrasound techniques are improving to recognize patterns from uric acid deposits, but again, access to advanced techniques is limited. For most patients, the analysis of samples is the only practical option, but this is painless if managed by a competent, experienced health professional.
Tophaceous Gout: Next Steps
Now you know what tophaceous gout is, your next step is to get it treated. Many people shy away from seeking treatment because they fear the tophaceous tumors. You should not fear them, but you should fear the likelihood of similar growths hidden within the joints where they cause permanent damage. See a doctor immediately. Maximum doses of the uric acid lowering medications described in the Gout Treatment sections are usually very effective at shrinking tophi. You should also discuss pain relief with your doctor for the early stages of that treatment, as lowering uric acid can cause gout flares from dissolving crystals.
Left untreated, existing tophi will grow larger, and will spread to more places in your body. I collect photographs and images of tophaceous gout, which you can find by searching for gout crystals in the search box at the top of each page.