Tophaceous gout is a severe form of gout that typically develops in people with chronic gout. Tophaceous gout happens when uric acid crystals form masses of white growths around the joints and tissues already affected by gout.

Gout is a common type of inflammatory arthritis that affects about 2 out of every 100 people in the United States. Arthritis refers to more than 100 different conditions that cause joint pain or disease.

People with chronic gout may develop tophaceous gout, which can affect any joint or soft tissue in the body, potentially leading to a reduced range of motion or even disability. However, treatments are available to alleviate the symptoms and minimize flares.

Read on to learn more about the causes, symptoms, treatment, and prevention of tophaceous gout.

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There are four stages of gout, and tophaceous gout is the most severe. It generally only develops in people with chronic, untreated gout, although it can affect people who have undergone a heart transplant.

Tophaceous gout occurs when uric acid crystals form masses of white growths that develop around the joints and tissues that gout has affected.

These masses, called tophi, are often visible under the skin and tend to look like swollen nodules. The material may be in a liquid, pasty, or chalky state.

Doctors diagnose tophaceous gout by taking a small sample from a suspected tophi and checking it for uric acid crystals. About 12–35% of people with gout develop tophi.

Gout causes inflammation in or around the joints and in the soft tissues surrounding them.

As a result, most people with gout experience:

  • severe pain
  • swelling
  • discoloration of the skin
  • warmth

Gout typically alternates between flares, which are symptomatic periods, and periods of remission, when there are no symptoms. Flares tend to come on suddenly — often within a few hours — and last for a few days or weeks.

It generally takes years for gout to become chronic. In many cases, early, effective treatment or management can prevent gout from becoming chronic.

Once a person develops chronic gout, masses of uric acid known as tophi can form under the skin and in other sites. It generally takes about 10 years for tophi to develop with gout. In some cases, however, tophi may develop with earlier stages of gout.

Depending on where the tophi form and their severity, size, and number, they can cause:

  • visible and physical deformity
  • joint or tissue damage
  • reduced range of motion or decreased ability to use a joint
  • disability
  • nerve pain by compressing or entrapping nerves

Tophi can damage and wear down bones as they grow. They may also become so swollen or compressed that they break open and drain uric acid crystals. If this occurs, the resulting wound can potentially become infected.

Tophi can affect any joint or soft tissue in the body. They can even develop in the joints or tissues of the ear.

Gout occurs when blood levels of uric acid are too high.

Uric acid usually acts as an antioxidant. The body makes approximately 66% of its uric acid supply naturally. The rest comes from the breakdown of chemicals called purines that are abundant in many protein-rich foods.

The kidneys regulate the levels of uric acid by filtering it out of the bloodstream for excretion in the urine. If the kidneys cannot filter out enough uric acid, or the body makes too much of it, it can build up in the bloodstream.

When blood uric acid levels are too high, known as hyperuricemia, some may leave the blood and form sharp, needle-like crystal deposits in joints and the soft tissues around them.

The immune system treats uric acid crystals as foreign particles, resulting in inflammation.

About two-thirds of people with hyperuricemia do not develop gout. Although it remains unclear why some people develop gout and others do not, it seems that certain risk factors may increase a person’s likelihood of getting gout.

Risk factors for gout include:

  • Sex: Males are more likely to develop gout than females.
  • Age: Males tend to develop gout between the ages of 30 and 45 years, whereas females tend to develop it aged 55–70 years.
  • Diet: Eating a lot of foods and drinks that are rich in purines or sugar can increase uric acid levels.
  • Alcohol: Drinking too much alcohol can also increase uric acid levels.
  • Family history: Having family members with gout means that a person has a higher risk of developing it themself.
  • Other medical conditions: Conditions such as high blood pressure, heart disease, kidney disease or injury, diabetes, metabolic syndrome, obesity, psoriasis, and some types of anemia can increase uric acid levels.
  • Medications: Many common medications, including diuretics (water pills), beta-blockers, aspirin, and cyclosporine, can increase uric acid levels.

During flares, people can often reduce gout symptoms using pain relievers or anti-inflammatory medications alongside ice, rest, and elevation.

Some prescription medications may also reduce symptoms if a person takes them soon after a flare begins. These include:

  • colchicine (Colcrys)
  • indomethacin (Indocin)
  • interleukin-1 blockers
  • corticosteroids

A person can also take prescription uric acid-lowering medications continually to reduce the risk of further flares and chronic gout. In people with tophaceous gout, the goal of treatment is to reduce uric acid levels to less than 5 milligrams per deciliter.

Medications that doctors commonly prescribe to reduce uric acid levels include:

  • allopurinol (Zyloprim), which decreases uric acid formation
  • probenecid (Benemid), which increases the filtering of uric acid by the kidneys
  • febuxostat (Uloric), which reduces uric acid production

A doctor may also prescribe different medications for someone if their current medications increase uric acid levels.

Daily routine adjustments can also help people with severe gout minimize their symptoms and reduce the risk of worsening flares. Changes that can help include:

  • staying hydrated, as water helps remove uric acid from the system
  • avoiding sugary drinks and foods
  • avoiding foods with a lot of purines, such as most seafood and meats
  • limiting or avoiding alcohol consumption
  • engaging in regular low impact exercise
  • maintaining a moderate body weight

With proper uric acid-lowering treatment, it tends to take at least a few months and possibly years for tophi to resolve.

Learn more about natural ways to lower uric acid levels here.

Small tophi do not require drainage, especially if they do not interfere with mobility. Uric acid-lowering medications are the first-line treatment for most cases of tophaceous gout.

People with large, numerous, disabling, or deforming tophi might undergo surgery to remove them and repair the damage they have done, but this is rarely necessary. Tophi that are in the tendons, the joints of the fingers and toes, or the fluid-filled joint cushions known as bursae might require surgery in rare situations.

Doctors generally try to avoid surgical treatment or drainage because of the risks of infection and poor wound healing.

Most routine adjustments that help a person manage gout can also help prevent it.

People can take the following steps to reduce their uric acid intake and lower the risk of conditions that can lead to gout:

  • eating a healthy, balanced diet
  • staying hydrated
  • managing their weight
  • getting enough exercise
  • avoiding or limiting sugary foods and drinks
  • avoiding or limiting alcohol intake
  • stopping smoking
  • treating hypertension, hyperlipidemia, and diabetes according to a doctor’s instructions
  • limiting the intake of foods and drinks rich in animal proteins, such as meat

Tophaceous gout is the most severe form of gout. It causes uric acid masses called tophi to form under the skin over joints and tissues.

People can usually treat tophaceous gout by using uric acid-lowering medications and changing certain everyday habits. Making these changes can also help a person prevent gout from developing in the first place.

It is important to contact a doctor as soon as possible if there are any signs of gout or tophi.