Gout and Tophi

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.

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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!

Tophi treatments

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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  • Nick Koliardos

    Reply Reply January 8, 2017

    Hi Spiro,
    I am in tears as I write this as it has just hit home how careless I have been with my looking after myself and in particular my diet/body. I am currently in the middle of the most horrendous gout attack which has lasted the longest ever this is now day 4. I have been suffering for around 18 years and My first attack was when I worked in Botswana in Africa – I live in the UK but worked for 6 years in Botswana eating the local meat which was sometimes freshly killed goat or sheep or cow together with drinking beer being a younger expatriate partying was normal.

    This all I am sure contributed to the first attack. There after I would say gout attacks happened yearly sometimes one every 2 years and sometimes 2 or 3 attacks a year. Usually very painful but would last 3days and the go taking colchicine and declophenic to make this happen. This is the first time when neither have worked and I am not incite pain but a sustained pain which subdues when rested and flares up as soon as I try and walk a little. I have bought your cook book and reading your writings have scared me, made me cry and you have made me look at now changing my life style and diet – I don’t want to leave my wife and son early as I want to grow old and see my son succeed get married and have children my grand children. I want to grow old with my wife and enjoy our retirement together.

    I am 50 now overweight and have been most of my adult life, not heavy drinker however drunk a lot when going out in my 20s and early 30s. I have high cholesterol and since diagnosed 10 years now take tablets daily. All the pains I have, the lump on my thumb knuckle, the feeling I sometimes have that my body is poisoned, the heart burn, the stomach burns, the aches in my finger joints etc. I now see are all interlinked and this together with the stress from work I fear will result in an early death. I fear I am entering stage 4 of this disease as you explain and must change my lifestyle now. I’m scared, concerned and in a bad place at the moment but will change to give my self the chance to be healthier not only for my sake but more importantly for my family.

    I thank you for your writings which have helped me come to this conclusion – this is serious – I never did take it seriously thinking I am indestructible but now I have to face reality and deal with it. With you assistance through the cook book etc I am sure I will. Thanks Nick Koliardos

    • Spiro Koulouris

      Reply Reply January 8, 2017

      Hi Nick!

      Thank you for sharing your personal experience with us. I am happy to hear that you are making the necessary changes in your life. It’s not easy but thinking about your family can be a great motivator.

      Good luck!

    • Christopher P Blackburn

      Reply Reply March 22, 2017

      Spiro, a gout attack for more than 4 days is normal for me. I’ve had attacks that would last more than a week. I’ve suffered from,gout for over 25 years. My first attack was when I was 21. I was in great shape then. Ate right, jogged 3 miles a day and exericed 1-2 hours,a day as well. I discovered I had gout when I went to the doctors after a forklift rolled over my foot. It didn’t hurt when it happened but about 2 days later my big toe swelled up and was very painful. I figured that forklift just have done more damage than I thought. A few X-rays later and nothing was broken. But, my bloodwork showed high levels of uric acid. I’ve never heard of gout before. I was prescribed allopurinol and it worked for about 5 years. Not one gout attack. But then 5 years in i suffered a major attack. It was more painful than my first and was laid up for 5 days. Then my attacks happened more often. On average one or two attacks a year only in my feet. During the following 5 years my doctor adjusted my meds. Adding daily doses of colchicine. This went on for a couple years with little success. They then referred me over to a specialist. He put me on uloric ( which is very expensibe. And continued daily doses of colchicine. I had a slight improvement on uloric. But that was short lived. Soon me uloric strength was increased. Another year or so with continued gout attacks and elevated acid level.

      I soon developed perifferal neuropathy in both my feet and legs due to colchicine. I then got tendenitis and rheumatoid arthritis in both my hands. And continued gout attacks in my feet, ankles, knees, elbows and hands. I’m now getting tophie in my elbows and my most recent attack in my hand has left a hard mass on the top of my hand near the wrist. It’s about the size of a grape.

      I’m only 46 years old and honestly I don’t believe I’ll live past my 50’s. I’ll be lucky to make it to my 50’s. I also suffer from heart arrhythmias, uncontrollable high blood pressure which is also believed to be caused by the colchicine affecting my nerves that control my heart rate. I’ve been hospitalized twice due to erratic heart rate and high blood pressure. Oh yeah, I’m also blind in my left eye due to having multiple surgeries throughout the years to fix my detached retina. I was diagnosed when I was only five with congenital membrane disorder in my left eye which resulted in no fluid being retained in my eye and causing my retina to form scars. My last surgery I woke up in the middle of the surgery and buckled causing the surgeon to slice my eye they had to remove my Lynn period I now have to live with the deformed guy and completely blind in it now. Prior I could at least see movement and Light. All I see now is Darkness.

      I know live on disability due to all my ailments in particularly my uncontrollable gout.

      I wish you luck and controlling your gout attacks.

      • Spiro Koulouris

        Reply Reply March 22, 2017

        I am sorry to hear that Christopher. Do what you can to stay healthy and always seek opinions from more then one doctor/specialist. I hope you are following a strict gout diet and wish you the best of luck.

  • Sue t

    Reply Reply September 6, 2016

    I’m 59, aches and pains everywhere and knee bad and ankles too. A month ago my finger and thumb got tophi. Such a shock for me! I’m now thinking I have gout all over my body because I’ve had bouts of “tendinitis” for over 10 years, when I can’t walk (bad feet, bad knees). My toes sometimes feel numb too. I have gout but it’s been ignored by my doctor. I have high blood pressure and I’m very overweight. No wonder I feel depressed! Doctor prescribed me antidepressants but I threw them away.

    • Spiro Koulouris

      Reply Reply September 6, 2016

      Hi Sue!

      Start taking action today! If you follow the dietary advice of this website and my ebook, you’ll see change in several weeks but you have to start somewhere. A disciplined gout diet is key and will change your life around. You can do it Sue!

  • Joseph Hughes

    Reply Reply July 15, 2016

    Last two years, had two big long attacks first attack developed tophi in knee. I never could really straighten it out and I did not worry about it. Next attack was 3 months long could not get out of attack. Attacked right knee, swelled it up, also left knee at the same time was basically crippled my sister got me on isogenex to akaline my body. I was not sure if it was gout or OA, went to doctor took x-rays told me my uric acid level was high but he wanted to send me to a specialist in knees. He said it looks like you might need a knee replacement,I said “you sure it is not gout”. He said he didnt think so.

    So I go see specialist and he says you have bone spurs, no cartilage I would do you knees tomorrow. I was scared to do knee replacement. I held off in the mean time, I was alkaline, my body for a couple of months thinking all hope was lost. The other night I had my legs elevated and felt a drop, was in pain. I could feel the tophi turning into a liquid and started going down my leg. It was not OA but gout doctor was going to give me knee replacement when it was gout.

    The gout probably was forming for years and took a few months of alkalizing. I can feel the corner turning. My knees are okay, if you have knee problems make absolutely sure it’s not gout becouse you can get rid of that. I wander how many people got pain and full knee replacement becouse they just did not alkalize their body to get rid of it. I believe doctor in my case did not give a shit becouse he did not want me to get an MRI to see the cartilage, so be careful of western diets, they cause inflamation and uric acid build up.

    • Spiro Koulouris

      Reply Reply July 16, 2016

      Hi Joseph!

      Thank you for your personal story with gout and tophi!

      Thanks for the advice and gout sufferers should always seek a 2nd opinion when a doctor suggests a knee replacement.

  • Ricardo

    Reply Reply July 9, 2016

    How can I remove my tophi??

    • Ricardo you have to go see your doctor and have it surgically removed.

  • Sameer

    Reply Reply May 1, 2016

    Hi I am 19 currently. I started having back aches when I was 17. I saw a doctor then got to know it was gout. I ignored it then I started facing leg aches. Afterthat I started taking pain killers. After 2 years I started plating football and got my knee tracked, I thought it would be due to football practice but as the days went by, my whole body started getting affected, my ribs, my neck and now my whole body is in pain. I started taking allopurinol but no effect. What should I do? No tophi has developed.

    • Hi Sameer!

      You need to go see a doctor and get at least 2 different opinions, it could be arthritis along with gout. Make sure to check it out!

    • Nick

      Reply Reply May 26, 2016

      Go see your dr. immediately & get a full panel of blood work to include uric acid level. Do you take any supplements like Creatine or powders contains it? If so, STOP!! If your uric acid levels are above normal, ‘start drinking black cherry juice (just cherry juice ONlLY…not the cocktail or the tart ) & drink at least a gallon of purified water every day. My 1st bought of gout my doc said that my uric acid levels weren’t high enough to have gout……what?!? She was WRONG.! I started drinking the juice & it worked! Every time I start to feel gout developing, that is what I do (along with following a gout friendly diet & bingo…flushed out in a matter of days. Good luck!!

  • Brendan

    Reply Reply December 25, 2015

    What percentage of peoe with gout develop tophi

    • Spiro Koulouris

      Reply Reply December 26, 2015

      There are no statistics that I can find but since it is rare, I presume anywhere below 3% of gout sufferers will go on to develop tophi.

  • Scooter

    Reply Reply November 26, 2015

    I was diagnosed with gout 3 years ago. While Allopurinol does a good job at preventing attacks (when I take it) I have notice some tophi on my finger, knee, and elbow. Right now they are still small and painless.

    Will taking my Allopurinol daily prevent any further growth? And should I take kristexxa?

    • Spiro Koulouris

      Reply Reply November 27, 2015

      Tough one! This is something that I can help you with, best to seek your doctor’s advice, all I can help you with is my dietary gout diet advice that can be found on this website and my ebook.

  • Prowler

    Reply Reply August 29, 2015

    I have never had a gout attack in my life.

    I have been drinking everyday for few years
    It has gotten worse in last 2 to 3 where I consumed 10 to 20 standard drinks a day.

    A few few months back I noticed a bump but ignored it. After a month of binging, I saw some more. I looked up online and it looks like gout tophi. They are on my ear under skin and painless. How can I treat them. I do not have insurance.

    • Spiro Koulouris

      Reply Reply August 29, 2015

      Prowler! I don’t know which part of the world you live in but you must see a doctor. There isn’t anything you can really do at home to treat tophi. One thing is for sure if you’ve been drinking alcohol 10 to 20 like you say, then give it up, you have to. Good luck!

  • Marty

    Reply Reply July 4, 2015

    Just got what’ve think is tophi bump. Should I be concerned? Was just moved from 100 to 300 mg a day of aliipurnol.

    • Yes Marty make sure to check it out, tophi is a serious complication of gout and you don’t want it to get worse. Trust me!

      • Jay Vansickle

        Reply Reply November 17, 2016

        Could taking allopurinol make a tophi lump worse?

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