Got Gout? How to Avoid Developing Tophi
Tophus or Tophi in plural is the same thing but what exactly is it? In Latin it is defined as a stone. Ouch! You know this post won’t be pretty! Very simply, it is a deposit in the elbow, toe, ankle, knee, ear, fingers or other joint in the body of monosodium urate crystals in people who’ve had high uric acid levels of over 6-7mg/dl for a prolonged period of time, a stage of gout’s development called chronic tophaceous gout. With time a tophus will grow and go unnoticed but then it will grow and bunch up together into bigger lumps of many tophi. Overall, 25% of gout suffers actually have tophi to some extent. Hard to believe that there wasn’t an actual treatment for it until 1951 when the drug phobenecid was first introduced. What did gout sufferers do before that?
Tophi should not be ignored when it first appears, although painless at the beginning, if left untreated the condition will worsen as they cluster together and more uric acid crystals form around the lump. What happens is our white blood cells attack the invading uric acid crystals so what tophi really is then is a collection of crystals and dead cells. This is not usually painful until they break out from the skin and appear as white or yellowish chalky lumps. It can cause havoc to one’s health by destroying the joints, cartilage and harming the organs (complications such as kidney stones) leading to noticeable disabilities.
Without any treatment, tophi can appear on average at about 10 years after being first diagnosed with gout but can develop earlier in older people although they can first appear anywhere between 3 and 42 years! In addition, tophi can appear or pop up suddenly overnight and sometimes the lump may actually grow so big that it must be amputated in order for the joint to be free to move again. This can also cause the tophi sufferer to end up getting an artificial joint. Furthermore, tophi usually appears in the coldest parts of the body in areas furthest from the heart and where obviously blood circulation is the poorest hence the appearance 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 but in many cases, tophi is usually painless and may cause only stiffness of the joints. On a sidenote, tophi can grow into the bones as well on top of them!
One thing is for sure, it is very difficult to treat tophi with a simple change in diet but you can definitely lower your risk of developing tophi by following a low purine diet avoiding too much meat, seafood, alcohol, sugars and drinking a lot of water, keeping those uric acid levels on the low end of the spectrum. Tophi’s growth can be stopped and beginning to dissolve when the uric acid blood levels begin reaching 6mg/dl and below but the majority of the time when tophi has formed, medical intervention is required, usually they are surgically removed. There is also the drug Krystexxa which can shrink the tophi quickly which is a modern uricase treatment, as well as febuxostat (EU brand name Adenuric, US brand name Uloric).
Prevention is the key to avoiding tophi in your lifetime while suffering from gout. Make sure to live a healthy lifestyle of a good gout diet, exercise, no smoking and following your doctor’s recommendations and you will be fine. If anybody has had an experience with tophi please leave your comments below and share your story!
Posted by Spiro Koulouris
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