Can You Have Tophi With Gout?

Yes, tophi are a common symptom of gout. Tophi are lumps that develop under the skin near a joint as a result of uric acid crystal buildup. They can be painful and can lead to joint damage if left untreated.

Dr Naveen Bhadauria is a substantive NHS Consultant Rheumatologist and private Rheumatologist operating from the world-renowned clinic rooms of BMI Cavell and Spire London East.

He specializes in caring for patients with all aspects of General Rheumatology, including Early Inflammatory Arthritis, Connective Tissue Diseases such as Lupus or Systemic Sclerosis, and conditions such as:

One area of particular interest for Dr Bhadauria is Gout Tophi. Gout is an inflammatory health condition caused by elevated uric acid levels in the body. Gout is widely known for causing patients a lot of joint pain, especially in the big toe joint.

What does gout tophi look like?

Tophi, or gout swellings, are rarely an early indication of gout. You can suffer from gout and experience joint pain without any obviously visible swellings around the joint. You may get skin redness, and the skin can feel warm to the touch, but gout tophi tend to develop in those whose gout has gone undiagnosed for a long time, and the affected joint has long-term damage from gout.

If left untreated, gout can become progressive. Gout flares can occur more frequently, and more joints can be affected. If the condition is continued to be ignored, it can cause more underlying damage to the joints. This is when tophi start to develop, and these large, highly visible bumps can form in joints, bones and cartilage.

Some patients develop gout tophi on their elbows, hands, feet, or even on the outer edge of the ear. Tophi can be easy to see due to their size and look like skin bumps, nodules or lumps that protrude from the skin. But smaller tophi can be hidden deeper under the skin and can be picked up by image testing, such as MRI.

Gout Tophi is a chronic gout health condition, otherwise known as chronic tophaceous gout or chronic gouty arthritis.

What causes gout tophi?

Excess uric acid causes a build-up of oxalate crystals that settles in a joint, causing excruciating pain, swelling, and tenderness. The joint can often feel warm to the touch, and the skin around the joint can look red and swollen.

An obvious side-effect of gout is a condition known as gout tophi. This develops when large fleshy bumps of urate crystals form around the joint where gout crystals have accumulated. Although the big toe is the most common area to be affected by gout tophi, it can also affect other joints, including knees, ankles, wrists, and elbows.

The tophi tend not to be painful, but there can be exceptions. Sometimes the tophi can become infected, which can cause pain. Depending on where the tophi develop, they can press down on underlying nerves to cause nerve pain, which can be potentially dangerous.

How long does it take for tophi to form?

It can take a while for tophi to form; sometimes, it can take a few months or years before you see noticeable tophi formation. The easiest way to avoid them developing in the first place is to get a proper gout diagnosis from a professional rheumatologist, such as Dr Bhadauria, at one of his London-based clinics. You can then benefit from treatment that will reduce the frequency and severity of gout flares.

Anyone diagnosed with gout and receiving appropriate treatment to control their condition will be less likely to develop tophi. You are more likely to develop tophi nodules if you suffer frequent and severe gout attacks. This is why it is essential to follow your doctor’s guidance to keep your uric acid levels in check.

Can you surgically remove tophi?

If left untreated, tophi can damage joints, cartilage and bones. Many people have an issue with the aesthetics of having tophi, as the outward appearance can be distressing. Over time tophi development can cause joint deformity and even disability.

It makes sense to do all you can to eliminate tophi, mainly because they are not necessarily permanent. Gout treatment from your rheumatologist can effectively decrease the size of tophi, and it can be possible to increase your medication for a few months to rid visible tophi and keep uric acid levels below where it can crystalize in the joints.

In rare cases, it is possible to have tophi surgically removed. However, surgery is only ever recommended if your condition is considered extreme. For example, if your tophi have become severely infected, is compressing nerves, or is causing you unmanageable pain or joint deformity.

Will allopurinol reduce tophi?

Allopurinol is a medication used for reducing uric acid levels in the body. Like other medications used to treat gout by lowering uric acid levels, it will help to keep uric acid levels below the level at which they can form crystals in bone joints.

For tophi crystals to dissolve, the concentration of uric acid in the blood must fall and be held below its crystallization point. Many rheumatologists will use allopurinol in combination with other medications to reduce tophi faster than allopurinol can achieve alone.

Book a consultation

If you suspect you are suffering from gout and haven’t yet sought a proper diagnosis, you can get a faster and more accurate gout diagnosis by booking a private consultation with Dr Bhadauria.

Inflammatory conditions can share many of the same symptoms, so having your suspicions confirmed or ruled out can be helpful. Dr Bhadauria and his team offer extensive and highly detailed diagnostic techniques that can give you a precise diagnosis and help you receive the most appropriate treatment and support.

Article by Dr. Naveen Bhadauria