What is Gout Tophi?

Gout tophi (pronounced TOE-fie) are deposits of uric acid crystals that accumulate in the joints and other tissues of the body. Over time, if gout is left untreated or not effectively managed, the uric acid crystals can accumulate and form tophi. Tophi are typically painless, firm, and often visible or palpable under the skin. They can develop in joints, such as the fingers, toes, elbows, and knees, as well as in other areas such as the earlobes and the soft tissue around joints.

hand gout tophi
Sample. Not my hand. Source: uptodate.com
foot gout tophi
Sample. Not my foot. Source: healthjade.net

Tophi are typically small, raised nodules or lumps that form under the skin or in the joints of individuals with chronic gout. They can vary in size, ranging from a few millimeters to several centimeters in diameter. Tophi are often firm to the touch and can feel like hard nodules beneath the skin. Their appearance can be described as follows:

Size: Tophi can range in size from very small, pea-sized nodules to larger, more noticeable lumps.

Color: They often appear whitish or yellowish, but they can also be slightly pink or reddish due to inflammation.

Location: Tophi typically develop in areas where joints are affected by gout, such as the fingers, toes, elbows, knees, and the soft tissue around these joints. They can also form in other areas, including the earlobes and the Achilles tendon.

Texture: Tophi are usually firm and may feel like gritty nodules under the skin. They might be mobile or slightly attached to surrounding tissue.

Overlying Skin: The skin over a tophus can appear normal or slightly reddened, and it might be thin or stretched due to the underlying accumulation of uric acid crystals.

Number: Individuals with severe and longstanding gout can develop multiple tophi in various joints and tissues.

Tophi are a sign of advanced or chronic gout and are associated with long-term, poorly controlled uric acid levels in the blood. They can cause joint damage and deformities if left untreated. Effective management of gout includes lifestyle changes, dietary adjustments, and medications that help lower uric acid levels and prevent gout flares and tophi formation. It’s important for individuals with gout to work closely with healthcare professionals to develop a treatment plan that addresses both acute flares and long-term management.

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