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.
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