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Gout is caused by high levels of uric acid in the blood, which can lead to the formation of uric acid crystals in the joints. Tophaceous gout occurs when these deposits increase in size, causing severe pain and inflammation. Treatment includes anti-inflammatory drugs, pain management, and reducing purine-rich foods. Surgery may be needed in severe cases.
Gout is a disease that causes the joints to suddenly burn due to inflammation. The main symptom of gout is a high level of uric acid in the blood. A diet rich in the amino acid called purine or a defect in uric acid metabolism are the main causes of this condition. Tophaceous gout, also called chronic gout, occurs in people with long-term high uric acid levels, which leads to the formation of large uric acid crystals in the joints.
Excess uric acid in the bloodstream can crystallize into monosodium urate, which is deposited on the articular cartilage, tendons and tissues surrounding the joints. Tophaceous gout occurs when deposits of monosodium urate deposits, also called tophi, increase in size. This usually happens after several years of high uric acid levels and minor gout symptoms.
The main symptom of gout is severe pain in the joints. The pain is caused by crystals forming within the joint, making movement painful, as well as inflammation that occurs around the joint. Often the joint is so tender that even a very light touch can cause severe pain. Other possible symptoms include low-grade fever, swelling, redness, and stiffness in the affected joints. Gout most often affects the big toe, but it can also affect the ankle, heel, or instep, or joints in the knee, elbow, wrist, toes, or spine.
In people with tophaceous gout, symptoms increase in severity as monosodium urate deposits become larger. As the deposits increase in size, they begin to spread outside the joint, causing large lumps under the skin. In advanced cases, the tophi can become so large that they break through the skin. Tophi are visible as chalky-looking white knots surrounded by red, inflamed skin.
Complications of tophaceous gout can become serious if the nodes are left untreated. Gout itself, as well as the development of tophi, can severely reduce range of motion due to pain and stiffness in the joints. Also, when tophi break through the surface of the skin, there is a risk that they may become infected or ulcerated. The infection can lead to a life-threatening illness called septicemia, in which bacteria enters the bloodstream.
Treatment of tophaceous gout includes anti-inflammatory drugs and medications to help manage pain and lower blood uric acid levels. If uric acid levels can be reduced to a consistently low level, the crystallized monosodium urate eventually begins to dissolve, reducing the size of the tophi nodes and helping relieve symptoms. Dietary changes, including reducing the intake of purine-rich foods, are also helpful. If these treatments aren’t enough to stop or reverse the progress of the disease, surgery to remove the tophi may be needed.
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