Gout and Tophi

Tophus and Tophi both refer to the same thing, but what exactly is it? In Latin, it is described as a stone. Ouch! You already know this isn’t going to be a pleasant read. Simply put, it is a deposit of monosodium urate crystals that develops in people who have had high uric acid levels of more than 6-7 mg/dl for an extended period.

These deposits can develop in the elbow, toe, ankle, knee, ear, fingers, or other joints in the body. Chronic tophaceous gout is a stage of gout development.

A tophus will grow and go unnoticed for a while, but eventually, it will grow and gather up into larger lumps of several tophi. Overall, around a quarter of gout sufferers develop tophi to some degree. Hard to believe that there wasn’t an actual treatment for it until 1951 when the drug probenecid was first introduced. What did gout sufferers do before that?

Tophi should not be overlooked when it first appears, even if it is painless at first. Tophi frequently appear as swollen, bulbous growths on your joints just beneath your skin. If left untreated, they will cluster together and more uric acid crystals will grow around the lump, making the problem worse.

Our white blood cells assault the invading uric acid crystals, resulting in tophi being nothing more than a collection of crystals and dead cells. This is usually not painful until the lumps break out of the skin and turn white or yellowish chalky.

If that doesn’t sound alarming enough, tophi will eventually cause even more serious health problems. Issues such as deteriorating joints, cartilage, and organs (as in kidney stones).

Needless to say, these complications WILL cause some very noticeable disability issues. Therefore, being able to spot and act on any symptoms before a full-blown gout attack is your best chance at avoiding unnecessary suffering.

Learn how to recognize the signs and symptoms of tophi

As we’ve already mentioned, on its own, tophi usually don’t cause the earth-shattering pain we feel from gout attacks. However, the sensations that come from the swelling are unmistakable and may quickly turn painful once the tophi get inflamed.

But if you don’t act on the symptoms on time your tophi will only keep growing in size and have painful effects. Over time, these horrendous formations will start disfiguring your joints. Therefore, prevention of a full-blown flare-up is your best bet to prevent further permanent damage.

Tophi may stretch your skin out and make it very tight, resulting in painful blisters. Tophi may split open and emit a soft, white material formed of hardened uric acid when this happens. This is as gross and as painful as it sounds.

The accumulation of tophi may trigger these symptoms of a potential gout attack:

• swelling, tenderness, and warmth around the tophus
• discomfort when using the affected joint or difficulty using it for several days after the attack has passed
• significant pain in the afflicted joint, especially in the hours after the onset of the attack
• losing range of motion in your affected joint, which may worsen if your gout isn’t treated

The four stages of gout

Tophi are a sign of gout, which is a disorder in which uric acid crystallizes in joints such as the feet and hands. Gout attacks are episodes of acute pain caused by gout. Gout may become a chronic illness if left untreated, increasing your risk of tophi and joint damage.

Tophi may not appear straight away if you have gout. There are four stages to gout:

1. Asymptomatic hyperuricemia: Even if your blood has high levels of uric acid, a disease known as hyperuricemia, you have no obvious symptoms.
2. Gout flare-up: When you have a considerable buildup of uric acid and crystallized forms in your joint, it may cause a lot of discomfort and inflammation. So much so that your joints start to feel warm to the touch. A classic gout attack symptom.
3. Gouty intervals: Between gout attacks, you may experience symptom-free periods or a break. These pauses might range anywhere from a few days to months or even years.
4. Chronically tophaceous gout: Tophi grow in your joints and the tissues around them at this stage. They are more likely to occur if you haven’t treated your gout for a long period (about 10 years or more). Tophi may also develop in the ears.

The emergence of tophi

Tophi emerges at an average of 11.6 years after an initial attack of gout and is characteristic of gout that has gone untreated for long periods. It may, however, manifest earlier in older persons, even though it may occur at any age between 3 and 42 years!

Tophi has been observed to appear or spring up seemingly out of nowhere. The lump may enlarge to the point where it must be removed for the joint to function normally again. As a result, the tophi patient may require an artificial joint.

Not only that but tophi are most commonly found in the coldest parts of the body, farthest away from the heart. These areas have less blood circulation, which is why they appear in the toes, ears, fingers, and ankles.

The symptoms of tophi include chronic joint pain and the visible lump in the joint. While the pain may be mild and include some inflammation, tophi are usually painless and may only cause joint stiffness. Tophi, however, may grow into the bones as well as on top of them!

Where can you find tophi formations?

Gout attacks are caused by an accumulation of uric acid. Although uric acid is generally excreted from the body through the kidneys, your diet or certain medical conditions may make it difficult for your body to do so. Uric acid builds up around the joints in this scenario.

A major study recently published on Nature.com compared clinical characteristics of patients with and without tophi at the time of gout diagnosis. The study investigated the link between tophi and renal function in gout patients. The presence of tophi was linked to a rapid decline in renal function, according to the findings. As a result, in gout patients with tophi, early diagnosis and vigilant monitoring of renal function were deemed to be critical.

Tophi may be present in nearly every joint in the body, including the foot, knees, wrists, Achilles tendon, fingers, and ears.

The most common issues in which uric acid accumulates up to create tophi are:

• tendons joining the joints to the muscle
• cartilage in the joints
• synovial membranes, which line the cartilage in your joints
• any soft tissues, such as fat or ligaments, in your joints
• in bursae which are small sacs that create a cushiony barrier in between the bones and soft tissues

Contrary to popular belief, tophi may also form in connective tissues that lie outside of joint areas. These include: 

• the white areas of your eyes, known as sclerae
• they may form in the renal pyramids. which are triangular-shaped sections of the kidneys made up of ducts and nephrons. These are known to help with the intake of nutrients as well as the expulsion of waste via the urine.
• in the heart valves like the aorta, although these formations are very rare

Tophi Treatments

Having tophi does not automatically imply that you will require surgery to remove them. If you catch them while they’re still small enough, you might be able to shrink them with the help of certain drugs or dietary changes.

One thing is certain: treating tophi with a simple dietary change is extremely difficult. However, you might significantly reduce your risk of developing tophi by eating a low purine diet, avoiding excessive meat, seafood, alcohol, and sugars. You should be drinking plenty of water, keeping your uric acid levels on the low-end spectrum.

When uric acid blood levels reach 6 mg/dl or lower, tophi growth typically begins to slow and dissolve.

However, when tophi formations get too large, medical intervention is usually required. Larger tophi usually require surgery because they can cause irreversible damage to your joint and reduce its range of motion. The following are some of the most common types of operations that your doctor may recommend:

• removing the tophus by hand after making a small cut on the skin above it
• if your joint has degenerated to the point where it is difficult to use, you may need joint replacement surgery

Of course, the best method to avoid having to undergo surgical operations to remove tophi is to avoid it in the first place. The following are some gout treatment methods that may help lower your risks of getting tophi:

1. Nonsteroidal anti-inflammatory medications (NSAIDs): Naproxen sodium (Aleve) and ibuprofen are examples of NSAIDs (Advil). These aid in the relief of pain and inflammation caused by gout episodes and tophi joint injury.
2. Inhibitors of xanthine oxidase (XOIs): XOIs help to lessen the risk of gout and tophi by reducing the amount of uric acid produced in your body. These medications include febuxostat (Uloric) and allopurinol (Zyloprim).
3. Inflammation-fighting corticosteroids: These are either injected directly into your joint or taken orally. One of the most commonly used corticosteroids is prednisone.
4. Uricosurics: These drugs work by assisting your kidneys in filtering uric acid from your bloodstream. Lesinurad (Zurampic) and probenecid (Probalan) are two medications that can help.

Other modern uricase therapies are being developed to help shrink tophi rapidly. Krystexxa and febuxostat (EU brand name Adenuric, US brand name Uloric) are two of them.

Natural treatments for tophi

Taking drugs is without a doubt the most efficient way to cure tophi and gout symptoms right away. Changing one’s lifestyle, however, is seen to be the greatest long-term strategy for overcoming tophi and gout. Lifestyle changes include activities such as losing weight, watching what they eat, and drinking lots of water.

Consuming certain nutrients is one simple strategy for making a lifestyle change (starting today!). These may be present in the meals you already eat regularly. Keeping these in mind, though, will help your body rebuild itself and strengthen its defenses more consistently.

You could try one or more of the following options:

• Coffee: Drink coffee! Coffee is quite effective in helping to reduce the risk of gout. Given the fact that most Americans start their day off by drinking coffee, this is an easy one.
• Dairy products: Again, milk is often a key part of a complete breakfast meal. According to a study, the proteins in milk may help bring down uric acid levels in the bloodstream.
• Vitamin C: Most people consume vitamin C daily, whether consciously or unconsciously. But now that you know it’s also an excellent way to lower the amount of uric acid in your blood, you’re probably going to want to up your Vitamin C intake in the future. Vitamin C is a vitamin that you can never have enough of!
• Cherries: In addition to being stacked with Vitamin C (and A and K), cherries are low in calories and chock full of fiber. They also include vital minerals, nutrients, and other health benefits. Even over a short length of time, eating cherries is useful in preventing gout attacks. Just take a look at this study that found that eating cherries for two days helped bring down the probability of gout attacks by 35%! So, if you want to jumpstart your gout and tophi treatments, this is a good (and utterly delicious) place to start.
• Plant-based treatments: A plant-based diet may be beneficial to gout patients. Plant proteins (especially nuts and legumes) may help you avoid gout while also giving a slew of other health benefits. Colchicine (Mitigare) is a popular plant-based medication that may help with gout pain relief.

The final word

If you’ve been diagnosed with gout, it’s critical to keep an eye on your uric acid levels regularly. This is especially true when you are asymptomatic and between attacks. It’s understandable to lose focus when your gout is dormant and you’re not in pain.

Prevention is the key to avoiding tophi in your lifetime while suffering from gout. You’ll be fine if you maintain a healthy lifestyle that includes a proper gout diet, exercise, quitting smoking, and adhering to your doctor’s advice.

You have a better chance of long-term success if you always manage gout effectively. You may prevent persons with tophi from having a lower quality of life because of their gout being left untreated for too long.

If anybody has had any experience with tophi, please leave your comments below and share your story!