Tophaceous Gout : Causes, Symptoms, Treatment

Tophaceous gout is known to occur in people with severe gout. It is seen mostly affecting people in whom the gout is left untreated and also those who have undergone a heart transplant.

Gout is a severe type of inflammatory condition that affects 2 out of every 100 people in the United States.⁽¹⁾

Tophaceous gout can affect any joint or soft tissue of the body and lead to reduced range of motion and can even lead to disability. Masses of white growth around the joints and tissue development in the areas affected by gout. These masses are known as tophi and are visible under the skin and look like swollen nodules. The material inside the tophi may be in a liquid, pasty or chalky state.⁽²⁾

12-35% of people with gout develop tophi.⁽³⁾ Tophaceous gout is diagnosed by taking a sample from tophi to check for uric acid crystals.

Gout occurs due to high uric acid levels.

Uric acid acts as an antioxidant. 66% of uric acid is made in the body naturally and the rest comes from the breakdown of chemicals called purines, which are abundant in protein-rich food.

The level of uric acid is regulated in the body by the kidneys. It is filtered out by the bloodstream to be excreted as urine. The inability of the kidney to filter out enough uric acid or if the body is making uric acid in excess, there is a build-up in the bloodstream.

The high uric acid level in the blood leads to the formation of sharp needle-like crystals deposits in joints and soft tissues around them.

The immune system treats uric acid crystals as foreign particles causing inflammation.

The risk factors for gout are:

• It more likely affects males than females
• Males aged 30 years to 45 years are more likely to develop gout. Females tend to develop it at 55-70 years of age.
• Eating excess foods and drinks rich in purines and sugar tend to increase the uric acid level.
• Excessive intake of alcohol increase the uric acid level.
• Having a family history of gout increases the chances of a person suffering from it too.

Certain medical conditions including high blood pressure, kidney disease, diabetes, metabolic syndrome, psoriasis, obesity and anemia increase the likelihood of increasing the level of uric acid in the blood.

Medications including diuretics, aspirin, beta-blockers, and cyclosporins can increase uric acid levels.

Inflammation in gout is in and around the joints, therefore people with gout experience severe pain, swelling, discoloration of the skin, and warmth. It can affect any joint or tissue.

There are periods of flare and remission and sometimes there are no symptoms. Flare tends to come suddenly within a few hours and lasts for a few days or weeks.

Gout may take years to become chronic. If people take medication this can be prevented. Once gout becomes chronic, a mass of uric acid comes under the skin and to other sites. It takes 10 years for tophi to develop with gout.⁽²⁾

Depending on the severity, number, and size of tophi they can cause:

• Visible and physical deformity
• Joint and tissue deformity
• Disability
• Reduced range of motion and decreased ability to use a joint
• Nerve pain due to compressing and entrapping nerves

Tophi can cause damage or wear down of the bones as they grow. Sometimes they get so swollen that they break open and drain uric acid crystals. This can result in wounds that can become infected.

During a flare of symptoms, a person can use pain relievers or anti-inflammatory medications along with ice, rest, and elevation.

Certain prescription medications are given that can prevent the risk of flares and chronic gout.

Adjustment in daily routine can also be helpful with every gout and can also reduce the risk of flares. The adjustments include:

• Keeping the body hydrated- This helps in removing uric acid from the body.
• Avoiding sugary food and drinks
• Limiting alcohol consumption
• Maintaining body weight
• Engaging in low-impact exercise
• Maintaining moderate body weight
• Avoiding food with purines

If the treatment is taken properly, it can take a few months for the tophi to resolve.

Surgery: In rare cases, surgery may be needed to repair the damage caused by tophi.

Tophi in tendons and joints of fingers and toes or in the fluid-filled joint cushions might need surgery.

Mostly, doctors try avoiding surgical treatment or drainage due to the risk of infection and poor wound healing.

Tophaceous gout is the most severe form of gout that lead to tophi forming under the skin over the joints and tendons. Uric acid lowering medications can be helpful in treating it and also lifestyle adjustments. It is important to discuss the case with a doctor as soon as possible.