Got Gout? How To Avoid Developing 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

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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 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!

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    65 replies to "Gout and Tophi"

    • Bridget Lodge

      I had tophi in my spine years ago, and said it was just incidental. Now having another gout attack in my spine (sacroiliac joint), and it’s all coming together. Severe, severe pain. I am serious this time about getting it together. Last gout attack I had when I was on the Keto diet (awful attack in my spine and right knee), and I followed it strictly. Back to sane eating without alcohol and red meat.

    • Karen

      This tophi is new to me. I thought I’d developed a bunch of warts on my fingers. I asked my Doc. What to buy to get rid of the warts and she told me my gout had developed into these things. So, I’m just starting working with the tophi and hope I can clear them up.

    • Jason

      I’m a chronic gout suffer and have had attacks in my toes, feet, knees, and elbows.
      Currently, I have what I think is tophi in both my elbows but it doesn’t look anything like the image in the article. Is tophi solid or is soft and pliable or can it be both? I have zero pain but I would like to remove it for appearance reasons.

      • Spiro Koulouris

        Hi Jason!

        It can be both solid or soft and pliable as you say. Go visit couple of rheumatologists and see what advice they each give you on how to get rid of it and take it from there.

        Good luck!

    • Jermaine D. Delos Santos

      I’m not against conventional treatment especially for a debilitating and excruciatingly painful condition as gout. But what I can only say is that, if people can help it, rather opt for preventative means than any invasive procedure when wanting to free oneself from the discomfort of the disorder.

      My mom had just previously undergone a surgery which extracted tophi from her knee and was expecting to get better. Sad to say, however, that that is not the case.

      She was still better off before the procedure took place than after it. Before going for the surgery, she could still walk just fine with little to no pains.

      2 or so months after the surgery, my mom is still getting nagged by pains caused by what we assume as another case of tophi which formed in her right knee.

      She had always been on a restricted diet, meant to reduce the uric acid level in her body, since her operation, but the pain still persists. Medications do not seem to add much help either. Even then, there’s the fear that the medications themselves might just cause another health problem.

      Bottom line: People should really choose to value their health by doing what’s right with their bodies e.g. eating healthy, not resorting to vice, etc. Then and only then are they going to be free from the discomfort which comes with the disease.

    • John Bigland

      I have a very big tophi on my right elbow, is it safe to have it removed? People have said it will never heal if operated on. I am 80 my uric acid is low and has been for some time.

      • Spiro Koulouris

        Yeah it should be. I recommend you see at least 2 different rheumatologists and see what they advise you to do. Then take it from there!

        Good luck!

    • Jerry Dildine

      Just a little info about me. My name is Jerry, I’ve had gout since is was 18, and I’m now 41. My gout has been diagnosed as chronic gout. Would have to say that the worst of my gout is in my hands, and has effected my elbows, writs, knees, and feet. In the past I’ve been one to not always take my medicine, and have ate and drank the wrong things.

      I had a severe flare up 3 weeks ago which hit my right elbow, wrist, and had. I’m still having swelling in my right hand, which I can’t use very much right now. I also have a large amount of Tophi that has been coming out of my right elbow, and have had Tophi coming out of at least three or four fingers at times.

      I’m really trying to get on board and make changes in my life. I quit smoking over a month ago, and have not had alcohol in three weeks. It’s easy to get side tracked in my line of work, but if I don’t change, I’ll be out of my line of work. I am currently taking 120 mg of uloric a day, .5 mg of colchicine a day. I have also given thought to the infusion treatment offered by a Doctor Becker out of University of Chicago.

      Any advice or help would be great fully appreciated

      • Spiro Koulouris

        Hi Jerry!

        Thanks for your comment!

        Unfortunately I am not a doctor so I can’t provide any medical advice but if I were you I’d get 2 different opinions from qualified rheumatologists.

        Now as for your diet I’d drink plenty of water and avoid any sugary beverages and alcohol. Coffee and herbal teas are fine too.

        Eat mostly complex carbohydrates as is fresh vegetables, legumes, beans for protein instead of meat, whole grain breads, pastas and rice.

        At the end if you have tophi ask your doctor if you can have it surgically removed.

        Good luck!

    • Mims

      Hi Spiro!

      I’m a female, just turned 50 and I’ve been having a gout attack for the past 2 weeks – my very first attack. The area beneath my left big toe swelled up and the pain was constant and unbearable even when my blanket touched the affected area. I only found out it was gout when I saw the doctor 2 days later and he confirmed it with a blood test that showed high uric acid.

      He gave me an NSAID and asked me to take it 3 times a day. Well, the severe pain went down rapidly BUT when the swelling went down a little, it revealed a lump on the top of the bone beneath the big toe which I have learned is tophi. Now after 2 weeks the area is still mildly inflamed, there is mild pain and the lump is not going away. I only take one NSAID at night because taking it in the day doesn’t seem to help.

      When I take it at night, the next morning there is hardly any pain but the walking throughout the day would see the area turn red, inflamed and mildly painful again by night. So I have been going through this cycle for 2 weeks and not getting anywhere. I’m surprised to learn that people usually get tophi after suffering gout for years but I got it on my first attack.

      I hardly eat meat or processed foods now, drink lemon juice in the morning and ACV in the evening and top up with water and green tea to make a total of 2.75L to 3L of liquids every day, took vitamin C and magnesium supplements and soaked my feet in ACV the past 2 days but I’m still stuck in that cycle. Not sure what else to do. Don’t really want to take the NSAID for too long as I’ve heard it’s not good for the kidneys and I’ve had problems with my kidneys before.

      • Spiro Koulouris

        Hi Mims!

        You can have the tophi surgically removed, seek the advice of a qualified rheumatologist who be able to provide you with the right advice on what to do for your situation. Yes taking NSAIDs long term does affect you. Tophi is very serious so natural remedies only provide temporary relief at best. A small surgery would be best route to go.

        • Mims

          Thanks for the quick reply, Spiro. It’s not the sight of the tophi that bothers me. It’s the inflammation that doesn’t go away whatever I do. Although I said it gave me ‘mild pain’ it’s still bad enough to prevent me from walking normally or putting on my shoes. I tried an ice pack on the tophi but while it felt better I have then read that ice may make the tophi crystalization worse. Is that true, do you know? On the other hand, soaking in warm ACV water yesterday actually made it worse and then the NSAID I took at night had no effect. So which is supposed to be good – warm or cold?

          • Spiro Koulouris

            Stick to your doctor’s orders cause tophi is very serious, we are not talking a traditional gout attack here where ACV can work or soaking your foot in water with Epsom salt. Talk to your doctor about surgically removing it and be done for it for good, instead of just taking a short term solution of fending off the symptoms with NSAIDs.

    • Dheeraj

      Hi Spiro!!!

      I am 28 years old and I used to weigh 157 kilos and I started diet and excercise and squash and reduced my weight to 92 kilos in 5 years. When I was 92 kilos I started suffering chronic pain in my ankles either right or left, it varies and I consulted a homeopathic doctor. He suggested to go for a blood test for uric acid and some calcium tests. This all happened in 2015 of January and he said it’s gout and should cut my bad food habits of meat and all.

      I was bed ridden for 15 days on my attack and later it used to attack for 8 months or so and in 2016 I got it once and in 2017 I got attacked in March and from then I took more care of my diet and until 2017 November I got viral fever attack. I got weak and on the third day of medication I had gout attack and it nearly stayed for 25 days this time. I couldnt put my feet on the floor and homeo worked for me so I’m on homeopathic medication, but my ankle still have mild pain on toe joint and ankle joint of my attacked ankle.

      It’s all good when I get out of bed and as I walk and move out and go for workout in the evenings I get pain on my ankle and toe. It increases and I feel a little more pain in my ankle and toe joint and again I give rest to my feel in night and wake up in morning, I don’t feel the pain in my ankle when I bend my toe backwards. I can feel the pain in the joint. I feel pain when im walking downstairs and if I get jerk in my ankle I feel the pinching on my ankle with pain in a sudden. I have been suffering pain from November 1 2017 to November 26 2017 with chronic and from then pain became mild but when I strain my ankle. I feel the pain increases and when I rest it whole night, it feels better in morning.

      I’m worried that tophi started in my toe joint and ankle or my ankle got weaken as it stayed chronic for 25 days. How should I get rid of this problem as the pain still stays as it’s winter? and in these years I again gained my weight to 118 kilos from 92. I wanted to workout and get rid of my weight but due to fear and pain in ankles I’m not making it possible like before. What would you suggest?

      How do I know that I didn’t develop tophi in my ankle as my feet looks normal but strained. Then the other one what should I have to do to get rid of this, can anyone help me…? I am weighing 117 kilos now and I try hard to reduce my weight. Which doctor should I consult? Ortho or neurologist for nerves.. how to test my tophi?…. Please help me!

      • Spiro Koulouris

        Hi Dheeraj!

        Thank you for your comment and question.

        You need to seek a qualified rheumatologist who specializes in arthritic diseases like gout, tophi and many others. A rheumatologist will properly diagnose you and do the correct tests. Rest assured!

        Let us know how it goes and update us.

        Good luck!

    • Alex Cavasin

      Hi Spiro!

      I have been battling gout for the past 20 years.
      Initially I had a few rare attacks and actually believed the missinformed doctors who, in retrospect, were just believing in old folklore like “rich foods…too much wine etc etc”

      After a while I started looking into how and when I would get an attack and slowly modified my diet accordingly.
      What I can tell you based on my experience is now proven by several modern research (in the past few years research on gout has intensified as the amount of sufferers increased exponentially) and that as well supports the observations I made as well, as new research.

      My gout became progressively worse in the past couple years, as lack of funds prevented me from keeping up my healthy diet I was used to. I turned to Probenecid a year ago but am still battling the occasional attack and my tophous deposits have not receded so far but I did notice that some of these softened and moved closer to the soft tissues of my joints in the knees and elbows. I can only say that even you here are still holding on to old myths. For one I found that beans and lentils are too high in purines and so are several other legumes, sugar in general is bad as it adds a double whammy by its acidifying effect. A diet higher in protein, especially dairy, is beneficial. Leafy green veggies are helpful as well as berries such as blueberries, strawberries, cherries, raspberries…just don’t over do it as fructose is bad as well.

      Limit your carb intake, potatoes, pasta and white bread…add healthy fats such as avocados, almonds etc and get your carbs from greens limiting net carbs and sugar production but in particular avoid processed foods at all costs as the preservatives are bad, and so are MSG and meat tenderizers. Red wine is good not bad (just don’t go drinking 3 bottles a day) but it needs to be said that alcohol consumption can increase the production of purines in the liver which then can lead to an attack…and this brings me to the next point.

      It is of course important to limit the purine intake in our system as purine is metabolized into uric acid…however, our body has its own purine production which is affected by our diet. A diet higher in proteins help keep the purine production within normal limits. Further to that I also need to add that most people, as in my case, ate underexcreters and not overproducers of uric acid and the main causes are usually the load we add to our kidneys with things that compete against UA in the kidneys. Our bodies actually need UA…we are some of the few mammals that can function with little or no salt because the UA in our system compensates for the lack of the mineral…this need of course gives the kidneys the ability to reabsorb UA, which happens in avg 7 times…but when we consume too much beer, or lots of NSAIDs (blood thinners and many other medications that are excreted through the kidneys) we increase the re-absorption rate of UA and end up with higher UA levels.

      So yes, a proper diet is essential, but not what most doctors and nutritionists tell you. Consuming lime and lemon juice, as well as other alkalizing elements, will help you avoid kidney stones as well as reducing the acid load.

      Probenecid and Benzbromarone are the two medications that are fairly safe and help reduce uric acid by increasing excretion through the kidneys. In my experience allopurinol and febuxostat not only don’t work but make issues worse by causing liver problems.

      In my case probenecid has made a significant difference in frequency and severity of gout attacks even though my diet is not back to the ideal standard I used to have. My deposits are not gone and…this would probably be my question for you now, have become increasingly painful lately, especially in my knees…any idea why and what I can do about it?

      • Spiro Koulouris

        Hi Alex!

        Thank you for telling us your story and providing some interesting insight. Unfortunately, I have no clue as to why your knees are hurting as of late but if I were you I’d be visiting a rheumatologist to check that out cause if you have suffered from gout for 20 years, it could be knee joint degradation that is caused from past gout attacks in the same joint over time.

    • Juli Grimes


      I too have gout but am unable to take the 2 medications that are prescribed for it. A few weeks ago, I noticed these hard white bumps on my first doctor said they were tophi,but said that surgery is a last resort as it tends not to heal well..mine is uncomfortable and tender at times.

      The other issue caused by this really high uric acid is, I have now gotten liver and kidney damage. My question and I do have many, is several years ago I had my gall bladder removed. Was that a precursor to the liver and kidney problems I am having now?

      Should I have known that I was going to have problems?

      When I was 20 I was told I had gout in my toe, the doctor thought it was funny and told me it was due to eating shellfish..he called it good living.

      In the last year I have had gout so bad in my left foot I could not walk for days and was on crutches . The doctor prescribed a really powerful anti inflammatory and it really did help; the only problem is with the liver and kidney trouble anti-inflammatories are not in my best interest. My back is kind of against the wall ..Any suggestions would be so helpful!!

      • Spiro Koulouris

        Hi Juli!

        Thank you for your comment!

        I don’t know about your gallbladder being the precursor, have you asked your doctor? they would know for sure, if you don’t like their answer, seek a second opinion.

        You have no choice, you must go on a very strict diet, I would even go as far to say that you should only eat complex carbohydrates, fresh vegetables, legumes, beans for protein, quinoa, whole grain breads, whole grain pastas, whole grain rices, seeds, nuts and very little fruit. Avoid meat, fish, chicken, avoid fat as well if you can. That means no fat coming from animal like eggs, butter, milk, cheese, yogurt…Get your fat from better sources like avocados and olive oil. No processed foods and no fried please. Try this you should feel better, to what extent nobody knows but I’m sure your liver and kidneys will thank you for it since these are foods that they can burn clean without much effort unlike meats and animal fats.

        Drink only water! Drink lots of it each day. Herbal teas and some coffee are fine as well but no juices, pop or alcohol.

    • Tom

      I have, what I was told by ortho, were spurs on my second toe. Could they be mistaken for spurs and actually be tophi? I had gout many years ago and have been on allopurinol 300 and colchicine .06 for years with no attacks. Very active 55, play baseball, softball, and volleyball I recently reduced sugar dramatically and lost 12-13 lbs. I was a big dessert guy and now I am not. I will eat red meat rarely (pun intended) when we go to restaurants and plenty of shrimp cocktail.

      I guess monitor your diet, stick with prescribed meds with a passion and see your doctor for blood work. I am on a boat load of medications. Keep moving and pay attention to your body!

    • Chris

      Hi, I’ve had gout for over 20 years and recently started getting tophi. I have some hard growth in one toe and a little bump in another. I recently had an attack and pricked one toe with blood and white tophi coming out. My attack is over but on my big toe joint I can feel and see that the remaining swelling has some play dough like tophi. First question… Why is it sometimes hard like bone and sometimes not? And if gout is caused by tophi crystals doesn’t it make sense to remove them before they harden or cause another attack? Thanks

      • Spiro Koulouris

        Hi Chris!

        Very hard question to answer, best if you ask your doctor about this. Your gout is very advanced already if you suffer from tophi, so medical attention is key here!

    • JC


      Many thanks for all of the information on this website. I believe I’ve gotten tophi in each pinky since approx November. The pain is very low on one side and a bit more then that on the right. A couple questions for you if you don’t mind.

      1). Should I see the general doctor, the Rheumatologist or both?
      2) Can it be diminished naturally via the diet changes recommended on this site. Or is drugs necessary?
      3). Does this seemingly minor issue mean that I might have deeper gout issues that I don’t know about? I would think I would know based on pain right?
      4) Do you know of any correlation between thyroid function (under active) and tophi and/or gout?

      Thanks again,

      • Spiro Koulouris

        Hi Jimmy!

        To answer your questions:

        1) your MD will be able to refer you to a rheumatologist who is more of a specialist when it comes to gout and other arthritic conditions. Why not have both! You can only get better treatment.
        2) It can for some but for most, drugs is the only option especially if kidneys are not operating at optimal levels. Regardless if you are on drugs or not, you need to maintain a healthy diet to avoid complications of gout like diabetes, heart disease, high blood pressure, arthritis, tophi and many other conditions that we are more at risk of developing since we have gout.
        3) If you have tophi it means you have a form of gout that is more advanced and needs medical attention.
        4) Yes according to this study having thyroid increase uric acid levels which eventually can cause gout.

    • Paul K.

      I have tophicious gout-bunion like deposits on my feet and elbows. Have had very few and far between painful episodes which would go away after taking a couple indomethacin. Just started taking allopurinol.

      Can tophi ever go away?

      • Spiro Koulouris

        Hi Paul!

        Yes tophi can go away, please go seek a qualified rheumatologist and he or she will be able to put you on whatever prescription drugs you need to get rid of it.

        Good luck!

    • jimmymanjones

      I have a weird one for you, would love an opinion.

      35yo and my first attack was 4 years ago in the big toe. 6 months later I literally fell down a flight of stairs barefooted and landed on that same toe, possibly even breaking it. Month long attack followed, horrendous pain, eventually my nurse practitioner (who didn’t know much about gout) put me on Uloric. This toe was permanently a little bit bigger than the other toe from here on out. The larger area always just felt like bone to me, and although I don’t know what tophi feels like, I actually assume it could have just been scar tissue from the fall. If it was tophi, the Uloric never made it go away (which makes me think maybe it was never tophi in the first place?).

      After a year my insurance stopped covering Uloric and I haven’t taken anything for 3 years with no signs of gout since that fall. Last month I got a very bad bacterial bronchitis and in the middle of that got a gout attack. The doctor thought low immune system could have caused it, but I don’t know.

      Anyway it’s been 3-4 weeks and the initial attack is gone, but the toe is still pretty red and swollen, some days worse than others regarding pain also. I’m wondering was it tophi all along and now it’s worse because of the attack, or is it just inflamed and I need to take NSAIDs until the swelling goes down? Again I don’t know what tophi feels like, but even right now it just feels like bone with a little bit of puffiness surrounding it. I guess I always assumed tophi would have a weird texture to it. Thanks for any help.

      BTW about a year after I had been completely off Uloric my uric acid tested 7.1.

      • Spiro Koulouris

        Hi Jimmy!

        Thank you for your story but it’s really hard to assess without knowing your full health situation but a traumatic injury in a joint can generate a gout attack but if it’s tophi or not, your doctor will have to tell you that. Best you seek a rheumatologist and they will be able to get to the bottom of it. With uric acid clocking at 7.1, you definitely need some medication to manage that to healthy levels.

    • Jimmy

      I have a fairly small tophi on my thumb and on my toe joint. I am trying something new and will share if it works. The product DMSO amongst other things passes easily through the skin and dissolves just about anything, so I thought it might dissolve the tophi. Have been applying it to my thumb for 2 weeks and it seems to help so far, but early days. Have you heard of using this product for gout? It also reduces inflammation, and it’s inexpensive!

    • Carl Joaquin

      I was 16 when I first had an attack. My hands were stiff and in a super painful state. I didn’t know it was gout until I had mt check-up. The doctor had me x-ray ed and uric acid test. I was diagnosed with TB and Hyperuricemia. It was very hard for me to adjust because so many foods are not allowed for me to eat. I am 17 now and still adjusting, I have tophi in the joint in my pointinf finger the size of a grape. I’tll be removed in a few days I hope so but it costs so much. As much as possible always live healthy and have a good diet to avoid gout because gout is literally hell.

    • Sharon Twitty

      I had surgery a year ago on what we thought was a tumor in a toe. It grew back so to avoid any more surgeries they amputated half of my toe. The pathology came back to day that is was a gouty tophus. I have zero symptoms, do not eat any of the foods on the bad list (a few processed and fatty meats) no alcohol maybe 20-25 lbs overweight, no kidney disease, no blood pressure issues no accompanying diseases of any kind…and now I have gout and it started with a tophus?

      I’m quickly studying up, but do you think uric acid levels would show up in my annual blood work or the surgical work up a year ago?? How rare is that? Any chance it is wrong?

      I am following up with my doctor to check on uric acid levels, but I am kind of shocked since I have nothing other than a tophus and half of a toe–not one other condition (until I see my uric acid levels). Will I lose more toes?


      • Spiro Koulouris

        Hi Sharon!

        Your case sounds very rare and I am not a doctor so cannot advise you here. If I were you I would recommend you get at least another 2 different opinions from different rheumatologists, doctors that specialize in arthritis related diseases like gout.

        Good luck!

    • Nick Koliardos

      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

        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

        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

          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

      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

        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

      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

        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

      How can I remove my tophi??

      • Spiro Koulouris

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

    • Sameer

      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.

      • Spiro Koulouris

        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

        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

      What percentage of peoe with gout develop tophi

      • Spiro Koulouris

        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

      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

        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.

    • […] Chronic Tophaceous Gout […]

    • Prowler

      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

        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

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

      • Spiro Koulouris

        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

          Could taking allopurinol make a tophi lump worse?

          • Spiro Koulouris

            It should not Jay!

            • Bernard Ngugi

              As am writing today am in a great pain on one of my ankles and knee. Along one of my ankles, there protrude a tumor which I keep on cutting and regrowing again and again. I have been fearing to see the doctor not to be told it is cancerous but the way you have described I have noted it to be gout. What do I do ?

            • Spiro Koulouris

              Please visit a doctor or rheumatologist quickly! There is not much that I can tell you Bernard. Your case is extreme and requires medical attention.

    • […] eat beans morning, day and night but you can eat them a few times a week. For those suffering from tophi please consult your doctor before making any attempts to eat beans since your body is more […]

    • […] complication of gout after many years is the development of tophi. Uric acid that deposits in the soft tissues especially around the joints can cause nodules known […]

    • […] your uric acid levels don’t get regulated in the long term, you can also end up with tophi around the spine which can wreak havoc to your back and can severely impair your ability to stand up. Take your gout […]

    • […] more frequent. This is the worst and most destructive stage due to the fact that you can develop tophi causing the destruction of the affected bone and cartilage to occur. This stage usually occurs […]

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