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If you experience symptoms of gout, contact your healthcare provider as soon as possible. This painful inflammatory disease is caused by monosodium urate crystals accumulating in your joints and soft tissue – the result of abnormally high uric acid in the blood (hyperuricaemia)1.

One of possible result of uncontrolled gout is tophi – significant deposits of urate crystals in your joints and bones1. These appear as large, visible bumps just under the skin that initially don’t cause pain2. However, if untreated they can burst, which may eventually lead to deformities2.

Medication-based treatment

The good news is that tophi aren’t necessarily permanent3.They can be dissolved with treatment and may disappear over time3. The best way to combat tophi is through urate-lowering therapy (ULT)1. Your healthcare provider will prescribe chronic medication, such as allopurinol, to lower the concentration of uric acid in your bloodstream1.

When ULT isn’t working

Unmanaged gout can cause chronic inflammation, which leads to chronic pain, joint damage, deformity and stiffness, so it’s important to stick to your prescribed medicine4,5. However, treatment isn’t always successful5. This might be due to late diagnosis, unsuitable therapy, other illnesses, poor diet/lifestyle, or abandoning treatment altogether5. In severe cases of chronic gout, where joint damage has occurred, your healthcare provider might recommend surgical removal of the tophi4,5. That’s why it’s always best to see your healthcare provider early for an effective non-surgical treatment plan.

References

1. Haines, A., et al. Assessment and management of acute and chronic gout. Can. Pharm. J. (Ott). 151(2), (2018).
2. Salama, A. & Alweis, R. Comm. Hosp. Intern. Med. Perspec. Images in clinical medicine: Tophi.7(2), (2017). 
3. Johns Hopkins Arthritis Center. Staff overview. Symptoms and Diagnosis of Gout. Available at https://www.hopkinsarthritis.org/arthritis-inf o/gout/clinical-presentation-of-gout/ 
4. American Kidney Fund. Staff overview. Complications of gout. Available at https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/complications/gout/complications-of-gout/
5. Słowińska, I., et al. Tophi – surgical treatment. Reumatologica54(5), (2016).