Chronic Tophaceous Gout

Since we focused on toe gout in our last post we decided to expand upon the topic this week to go into some of the details of this form of toe joint arthritis and look at some of the possible complications caused by tophi in the toe and what risks you face if you have tophi as well as ways to remedy chronic tophaceous gout.

Tophi Overview


A tophus or tophi (tophi being plural) is a small collection of monosodium urate crystals that form in one’s joints cartilege or bones. The crystals are commonly observed alongside toe gout and although both these issues are related to high levels of uric acids in the blood, they are not the same. Gout is caused by the inflammation of the joint from uric acid pooling in one area, a tophus usually comes after gout and can actually break through the skin in yellow or white crystals.


Tophi Causes

Toe tophi are caused by the heightens levels or uric acid in the blood stream, the same problem that causes toe gout. The excess acid forms into urate crystals that then cluster together. These clusters bunch around a joint, ligament or cartilege and then continue to grow in size.


Tophi Symptoms

If there is no intervention, these crystals usually form approximately ten years after gout has set into the toe joint. Men and the elderly are more at risk for tophi formation and the the crystals can seemingly pop up suddenly as if over night. If you stretch the skin over the area you suspect contains a tophus you may be able to spot a cream coloured area where the crystals have formed.

During a gout flare up, the crystals may push themselves through the skin or you may notice a growing lump in the toe joint. As tophi accumulate in a toe joint they can sometimes form a very visible clod that is noticeable tot he naked eye. The clump can actually grow so large that it must be amputated in order for the joint to be free to move.

The symptoms of chronic tophaceous gout are most apparent as chronic toe pain and a visible lump in the toe joint. The pain may be mild and include some inflammation from the accompanying gout, but in many cases the tophi are painless may only cause joint stiffness.


Tophi Treatment

Chronic tophaceous gout treatment can rarely be treated by simple diet changes. It’s possible to lower the risk of chronic tophaceous gout by following a low purine diet and avoid red meat, sea food and alcohol as these reduce the uric acid levels in the body. Tophi’s growth can be halted, and the tophus can actually be dissolved if blood uric acid levels reach 6 mg/dL, or below. Drinking water can help to dilute the uric acid levels, however once tophi have become to form, medical intervention is usually required.

Drug companies have been developing a variety of medication to deal with chronic tophaceous gout such as Febuxostat, Uloric and Krystexxa. Your doctor may prescribe traditional nonsteroidal anti-inflammatory drugs (NSAIDs) which include ibuprofen or naproxen in order to deal with the pain of a gout attack.

When much tophi has accumulated surgery is usually required to remove the crystals from the joint. It’s likely you will be able to know if you need surgery, the cream coloured crystals will be evident beneath the skin and a sizable lump will have formed. The most important thing to do is to recognize when you have toe joint gout and take action prevent tophi from forming in the long run.


Tophi Summary

Prevention is key for avoiding tophi and the formation of tophus crystals in the body. Large deposits can visibly deform the joints affected and can be linked to other complications such as kidney stones. Keep an eye on your uric acid levels and work to lower them by drinking water and avoiding high purine foods. Remember, tophi generally take 10 years to form after the onset of gout, making sure the toe gout doesn’t turn to chronic tophaceous gout is important.

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