What are Tophi?

Emma Lloyd
Emma Lloyd
Tophi are lumps that appear on joints affected by gout and are made of crystallized uric acid.
Tophi are lumps that appear on joints affected by gout and are made of crystallized uric acid.

Tophi are lumps that appear on joints affected by gout. They are made up of crystallized uric acid, a substance that is present in abnormally high concentrations in people with gout. A tophus may develop on the finger, toe, ankle, and elbow joints, and on the ears. Generally, multiple small lumps develop, and over time, one or more may grow much larger.

Because beer has high levels of purine, it's the beverage that's most closely associated with gout.
Because beer has high levels of purine, it's the beverage that's most closely associated with gout.

Gout is an inflammatory joint disease that develops as a result of high uric acid levels. This can be caused by a metabolic abnormality that causes the body to make too much uric acid, or prevents the body from excreting uric acid. Diseases, such as renal failure, may also lead to the development of this condition. Alternatively, the disease may be caused by a diet rich in foods that are high in purine, a component of nucleic acids.

Gout may cause some individuals to sweat excessively.
Gout may cause some individuals to sweat excessively.

Tophi tend to develop after several years of chronic disease. Generally, these lumps grow when gout is untreated for a considerable length of time, or when the condition is not effective at managing uric acid levels. Gout treatments reduce uric acid levels as much as possible, so when the condition is managed effectively, the lumps are an uncommon development.

A high body mass index is considered to be a major risk factor for diseases such as gout and diabetes.
A high body mass index is considered to be a major risk factor for diseases such as gout and diabetes.

When they do begin to develop, they may go unnoticed until they begin to protrude above the skin. The lumps often grow into a joint before they begin to protrude. This means that by the time a tophus is noticed, it may have already begun to damage the joint upon which it grows. The lumps grow larger as more uric acid is deposited, and they can become extremely painful, as they may destroy a large amount of the bone and cartilage of the joint. Sometimes, one may break the skin, potentially causing severe infection of the bone or bloodstream.

Injectable drugs may be used to soothe joint pain caused by gout.
Injectable drugs may be used to soothe joint pain caused by gout.

Smaller tophi can be treated with a regime of gout treatment to manage uric acid levels. Once levels of uric acid in the blood begin to decrease, the lumps gradually dissolve as the crystallized acid is absorbed into the bloodstream. In some cases, however, this treatment will not effectively treat the condition. Surgical removal of the lumps, and repair of joints, may be needed. A large one that has invaded a joint or broken the skin is likely to need surgery.

Tophi may be treated surgically.
Tophi may be treated surgically.

Surgery to remove a tophus involves the removal of the lump and draining the joint. The procedure may be difficult, especially when the crystals have invaded the joint. In cases where the lump has broken the skin and formed an extensive ulcer, skin grafts may be used to help the wound heal. High uric acid levels must be managed following surgery to prevent these lumps from reforming.

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Discussion Comments

anon325910

I have been getting gout since I was 27, and had surgical removal of tophi from my big toe when I was about 34. I then started taking allopurinal daily, and continued taking it until i was 46.

I stopped taking it, and now about a year later I've noticed the tophi has returned in the same area. I stopped taking it because I stopped drinking, and I didn't feel I needed it anymore, yet it's back, but not quite as severe yet. Any advice?

anon66841

For some reason the gout attacks my wrists more than anyplace else. I just had surgery to remove tophi in the carpal tunnel area which was causing extreme numbness in some of my fingers. Is this unique or more common than I think?

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    • Tophi are lumps that appear on joints affected by gout and are made of crystallized uric acid.
      By: Alila Medical Media
      Tophi are lumps that appear on joints affected by gout and are made of crystallized uric acid.
    • Because beer has high levels of purine, it's the beverage that's most closely associated with gout.
      By: BRAD
      Because beer has high levels of purine, it's the beverage that's most closely associated with gout.
    • Gout may cause some individuals to sweat excessively.
      By: blanche
      Gout may cause some individuals to sweat excessively.
    • A high body mass index is considered to be a major risk factor for diseases such as gout and diabetes.
      By: Rozmaryna
      A high body mass index is considered to be a major risk factor for diseases such as gout and diabetes.
    • Injectable drugs may be used to soothe joint pain caused by gout.
      By: Andrei Tsalko
      Injectable drugs may be used to soothe joint pain caused by gout.
    • Tophi may be treated surgically.
      By: h368k742
      Tophi may be treated surgically.