Identifying Tophi
identifying tophi

Gout, a painful and prevalent condition, is caused by the accumulation of urate crystals in joints, most commonly in the hands and feet. While gout alone is challenging to endure, it is often accompanied by additional symptoms, notably tophi (singular: tophus). While tophi do not typically cause pain initially, they have the potential to become inflamed and swollen, leading to discomfort and permanent damage. In this blog, we will delve into the intricacies of tophi, exploring what they are, their significance, and how to identify them. 

What are Tophi? 

Tophi are a common characteristic of uncontrolled gout. Tophi are stone-like deposits of monosodium urate crystals that accumulate in the soft-tissues, synovial tissues, or bones near the joints of individuals with chronic gout. These crystalline deposits form when there are high levels of uric acid in the bloodstream, leading to the crystallization of sodium urate. White blood cells of the immune system try to dissolve the uric acid crystals. But when the immune system cannot keep up with all the crystals, the excess uric acid settles in clusters that develop into tophi.  

Tophi typically develop over time, often found in the soft tissue of joints that are affected by gout attacks, and especially in areas of the body that have experienced trauma.  

Signs and Symptoms: What do Tophi look like? 

Tophi present with distinct signs and symptoms. Visible signs include the presence of bulbous or “bumpy,” chalky deposits just beneath the skin, often appearing cream-colored or yellowish in color. The overlying skin may be thin and red. Tophi may feel firm or gritty to the touch and can cause swelling, tenderness, and limited range of motion in affected joints. In some cases, tophi may rupture through the skin leading to ulceration, discharge of chalky material and ultimately infection. 

What does a gout tophi look like 

Diagnosing Tophi  

Diagnosing tophi typically involves a combination of clinical examination, imaging, and laboratory tests. During a physical examination, healthcare providers may feel affected joints to detect the presence of nodules” or bumps indicative of tophi. X-rays, ultrasounds, and MRIs can provide further insight into the extent and location of tophi deposits. Laboratory tests, including serum uric acid levels and joint fluid analysis, may also support the diagnosis of gout and tophi. 

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Understanding the Importance of Identifying Tophi Early 

Identifying tophi is crucial for several reasons. Firstly, tophi serve as a visual indicator of advanced gout and can aid in confirming a diagnosis. Secondly, the presence of tophi is associated with an increased risk of gout-related complications. Tophi can erode bone and destroy cartilage, causing irreversible joint damage, deformities, and reduced mobility. Additionally, tophi can cause pain, inflammation, and discomfort, impacting a patient’s quality of life.  

Early detection of tophi is critical for initiating timely interventions and preventing gout progression. By identifying tophi in the early stages, healthcare providers can implement strategies to lower uric acid levels, reduce inflammation, and dissolve existing tophi.  

Prompt treatment can help alleviate symptoms, prevent further joint damage, and improve long-term outcomes for patients with gout. Depending on size and location of the tophi, treatment options may include medication that lowers uric acid levels in the blood, and in some cases surgical removal. These medications may include: 

  • Biologic medications, including KRYSTEXXA and ILARIS 
  • Oral medications, including allopurinol or febuxostat 

Tips for Identifying Tophi 

Tophi occur in 12% to 35% of people with gout. Tophi generally develop in the joints and tissues in the advanced stages of gout. This occurs an average of 10 years after an initial attack of gout and is characteristic of gout that has gone untreated.  

A few signs that you may have tophi include: 

  • Swollen, warm, or red skin around the joints, especially the big toe, fingers, wrists, Achilles tendon, or inside the ear (at the anti-helix) 
  • Pain near the site of swelling that comes and goes in flares 
  • Firm, gritty, bumps around the joints 
  • Worsening range of motion near the affected joint7 1 

It’s important to visit your doctor or gout specialist if you are experiencing any of the above symptoms.  

If you are dealing with gout attacks or painful symptoms such as tophi, give us a call or send us a message to schedule your in-person or virtual visit today at Summit Rheumatology’s Gout Center of Excellence. 

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