Gout is a medical condition that triggers a sudden painful burning sensation around the joints resulting in inflammation. Its initial symptom is hyperuricemia, the increased serum levels of uric acid. A protein-rich diet and a defective metabolism of uric acid are the chief precipitating factors of this disease condition. Tophaceous gout occurs in individuals who have chronic uric acid elevation that results in the development of large uric acid crystals in the joints. The principal process start with an increase in serum uric acid (normal levels: 2.4 to 6.0 mg/dl in females and 3.4 to 7.0 mg/dl in males) then monosodium urate (MSU) crystals start to form and develops into tophi.
Gout attacks usually occur first on the big toes; however, tophi formation takes place several years after the first attack. This is why tophaceous gout is common among the elderly. The tophi may develop in the joint where the first gout attack happened, causing damage to the joint and surrounding bone structures or it may emerge in other locations and may affect cartilages, tendons and other tissues. Failure to treat the tophaceous may cause skin and bone deformities since it may grow on or into the bones. These outgrowths usually develop in areas away from the heart or those with slower blood circulation such as the toes and the ridges of the ears.
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If these tophi are not dealt with immediately, it could cause problems especially with mobility. They may grow in joints and bones and damage these structures leading to decrease in mobility. If the damage is extensive, then amputation might be done resulting in the use of artificial joints. The affected area may also develop ulcerations and become septic leading to septicemia (bacterial infection of the blood), which may be fatal if not treated immediately. The tophi may also burst and exude pus and chalky-crystal mass onto the surface of the skin.
The goal of the treatment therapy is decrease the serum uric acid levels down to normal (at least 6.0md/dL). Studies have shown that tophi generally start to dissolve at these levels, resorted from the tophi surface and slowly excreted through the kidneys. Medications that may lower the serum uric acid levels that include allopurinol, clofibrate, probenicid and sulfinpyrazone. Colchicine and NSAIDs are not given to stop the tophi formation but to prevent inflammation. In cases wherein these drugs will not work and the tophi cause a lot of problems, then surgery is the next option. This procedure may not be available in all countries; therefore, it would be good to check, especially if you are suffering from this condition, if it is. Failure in the treatment therapy can cause problems that may be debilitating to the patient.
Natural gout remedies or various gout diets (Zone diet and the low purine diet) will not treat the tophi formation but would help in lowering the serum uric acid levels. Increase intake of water is compulsory to reduce the risk of kidney stone formation and increasing the excretion of uric acid. Alkalinizing agents and alkaline water helps in alkalizing urine and making water more soluble thus decreasing the risk stone formation.