Tophi are white or yellowish-white nodular masses containing crystals of monosodium urate, which often form in soft tissues in more than 50% of patients with gout that has not been properly treated. They are usually painless and tend to develop on average of 12 years after the first gout attack. Chronic tophaceuous gout is known as Harrison Syndrome. Only rarely do individuals develop tophi before experiencing an acute episode of gout.
Tophi typically form on toes, heels, fingers, forearms, elbows and knees; however, they can occur anywhere in the body, even in the spinal canal or vocal chords. Women who are being treated with diuretics are at greater risk of developing tophi.
In cases involving the joints, if not properly treated, pain may present itself among the damage to the joint structures. Occasionally, the white, paste-like material present inside the tophi can become inflamed and begin to leak, eventually leading to the formation of real ulcers.
If tophi become too large or painful, their development can limit joint function and cause bone destruction, leading to noticeable disabilities such as difficulty dressing or eating. The likeliness of developing permanent joint damage is increased if gout is left untreated. In more severe cases, tophi may need to be surgically removed.
What diseases may be associated with tophi?
Tophi are typically associated with tophi gout. Gout is caused by a buildup of uric acid in the blood. Too much uric acid can cause microscopic crystals of sodium urate to form, generally in joints or surrounding tissue. They can trigger a reaction in the joint cartilage, causing severe pain and inflammation associated with a gout attack.
Medical conditions that can increase the risk of developing gout include the following:
- Diabetes (Type 1 and Type 2 diabetes)
- Osteoarthritis
- Kidney disease
- Hypertension (high blood pressure)
- High levels of cholesterol in the blood
- High levels of fat in the blood
What are possible treatment options for tophi?
In order to act on the tophi, it is first necessary to reduce the levels of uric acid in the body. Occasionally, high levels of uric acid can lead to the formation of uric acid crystals in the urinary tract, which in turn result in kidney stones. Most kidney stones are small and can pass through the system within a day or two; however, some kidney stones can interfere with urine flow, resulting in pain and possible infection in the urinary system.
Making certain lifestyle changes such as reducing alcohol and food intake high in purines, losing weight, modifying intake of diuretics and taking certain prescription drugs can help reduce uric acid in the body.
When is it advised to consult with a doctor regarding tophi?
Seeking medical attention promptly is advised in cases where tophi occur, in order to reduce the risk of further damage to the joints. Consulting with a doctor in regards to further testing may be necessary to either confirm the diagnosis of gout or rule out other conditions.
Also, follow up appointments may be necessary in order to check uric acid levels in the body and deal with or prevent further gout attacks.
