What is Tophaceous Gout and How Can I Manage It?

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Tophaceous Gout
Tophaceous gout is an advanced, chronic stage of the disease characterized by the development of large deposits of uric acid crystals usually in your joints, cartilage and bones, forming nodules, or lumps known as tophi.

Here, we’ll discuss the details of this condition, including how it develops, its signs and symptoms, and its potential effects on your body, as well as what can be done to manage its more troublesome symptoms.

What Is Tophaceous Gout?

Gout is a form of inflammatory arthritis caused by excessive amounts of uric acid in the bloodstream, a waste product that is normally excreted via urination. This can be caused by excessive production of this natural chemical by your body, or an impaired ability to remove it. Excessive levels of this substance can cause sharp, needle-like crystals to form in joints and soft tissues, prompting the classic symptoms of gout – intense pain and swelling in an affected joint, as well as redness and warmth.

These symptoms come and go in the early stages of gout, with periods of remission, when you are symptom free, between attacks. However, after several years of repeated attacks, the disease can progress to chronic form, called tophaceous gout. This condition is characterized by chronic low-grade pain, joint inflammation and the development of tophi.

Tophi are deposits of the above-mentioned sharp uric acid crystals that gather together to form hard lumps in your joints, cartilage and bones. The most common locations for the development of these masses include the feet, ears, hands, elbows, knees and forearms. They can also develop in the kidneys and other organs, and in rare cases, these nodules can form around the heart or spine.

Some tophi are painless, but the pressure they place on your joints can result in joint pain and stiffness. Over time, they can wear away your cartilage and bone, destroying joints. Large masses beneath your skin, on the hands and feet for instance, can cause severe deformities and impair joint function, becoming disabling, and in some cases, they can break through the skin revealing the yellowish or white chalky masses. Occasionally, nodules can sometimes become inflamed and produce a discharge of pus and crystals.

Managing Tophaceous Gout

The most effective means of managing this chronic form of the disease is acid-lowering therapy, which uses medications to reduce levels of uric acid in your bloodstream. These medications work in one of two ways: by reducing the amount of uric acid produced by your body, or by increasing the ability of your kidneys to remove it. By lowering this substance below the level necessary for crystal formation, existing nodules will generally stop getting larger, then, in most cases, will begin to shrink gradually as their crystals dissolve, often disappearing entirely with continued treatment. Acid-lowering therapy generally must continue for the rest of your life, if you have this form of gout, in order to prevent symptoms, including tophi, from returning.

Lifestyle changes are also an important part of managing symptoms of tophaceous gout. If you have this issue and are overweight, you may be advised by your doctor to follow a weight loss plan, since those extra pounds can cause uric acid levels to rise. Dietary changes are also frequently recommended by your physician, with the chief concern being the reduction of purines in the diet. Purines are natural chemicals, present in many foods, which are broken down into uric acid by digestion, increasing levels of this acid in the body.

Perhaps the most important thing for you to know about managing this chronic form of gout is that early treatment is best in terms of reducing or resolving existing tophi, preventing the formation of new masses and avoiding the damage they can do to your joints, organs and soft tissues. With early, aggressive treatment and beneficial lifestyle changes, the effects of this form of the disease may be limited, allowing those affected by it to live healthy, active lives, free of the disfiguring and disabling affects that can occur if the disease is allowed to progress untreated or under-treated.