Gout is a troublesome condition that affects the joints. It is one of the most common and painful forms of arthritis. Gout occurs in individuals who have an excessive buildup of uric acid in the body. Uric acid accumulates over time and forms crystal deposits in the joints, particularly the ones found in the big toes. A common form of gout is known as tophaceous gout. Learn what it is, what its symptoms are and what gout treatment is best.

What Is Tophaceous Gout?

Tophaceous gout occurs as a result of prolonged cases of chronic gout. It usually develops in individuals who have had gout for at least 10 years. It is named after the term ‘tophus’ (plural ‘tophi’), which are crystals made of monosodium urate.
Tophi usually form in the joints, bones and cartilage, although these could also be found in other areas of the body. There are cases where pieces of tophi could travel towards the skin surface where they could appear as whitish or whitish yellow nodes. Tophi can develop within 10 years if gout is not treated when it first appears.


The most common symptoms of this condition include severe pain and tenderness felt in the joints. Crystal deposits in the joints make it difficult and painful to move. The more deposits there are, the more painful the joint. Some chalky-white or pink spots and nodes may also appear on the skin. In most cases, the skin around these nodes will appear swollen and reddened. Tophi that breaks the skin may also increase the risk of developing an infection. Once the spots become ulcerated, they could even lead to septicemia, a life-threatening illness.

Treating Tophaceous Gout

The best way to treat tophaceous gout is to prevent it. The disease is very uncomfortable and in later stages can cause severe, debilitating pain. Maintaining a healthful, balanced diet is a good start, one that does not include foods rich in purines. Drinking plenty of fluids will also help keep the kidneys more efficient in flushing out toxins.Diet also plays a key role in managing pain and inflammation in case gout is already present. A good diet helps prevent the formation of more uric crystals and allows the body to regulate the amounts still left in the body.

Any pain and discomfort may be treated using prescription medications including non-steroidal anti-inflammatory drugs or NSAIDs, corticosteroids and/or colchicine. NSAIDs are used for the treatment of acute inflammation and for alleviating mild to moderate discomfort and pain by affecting the synthesis of prostaglandins. The type and duration of use often depends on the response of the patient. Some patients may also do well with controlled daily doses of either colchicine or NSAIDs.

In small amounts, these medications can help control inflammation and thus reduce the severity and frequency of attacks. Doctors may also prescribe medicines that reduce uric acid levels in the blood. Some of these medications include probenecid and allopurinol. These treatments may sometimes be given in conjunction with colchicine to prevent any attack due to the decrease in uric acid.

Once the amount of crystallized MSU is reduced, the deposits simply dissolve gradually, reducing pain and making it easier for joints to move. As uric crystals dissolve, tophi will also shrink.

Is Surgery An Option?

Surgical removal of hardened tophi can be the only option in cases where the progress of  tophaceous gout can no longer be reversed or stopped. Surgery is also an option where complications are present, such as ulcers, infection or joint deformity. Healing and full recovery of tophaceous gout will depend on the patient but prognosis is generally good.

News Update

FDA Panel Nixes Gout Drug. Med Page Today. The panel expressed particular concerns about use of the drug in all patients beginning allopurinol treatment noting that most clinicians would be likely to reserve rilonacept for patients with severe tophaceous disease or for patients at high risk and more.…