Gout is a disease that causes sudden burning pain in the joints, due to inflammation. The main symptom of gout is an elevated level of uric acid in the bloodstream. A diet rich in the amino acid called purine or a defect in the metabolism of uric acid are the main causes of this condition. Tophaceous gout, also called chronic gout, occurs in people with long-term elevated uric acid levels, leading to the formation of large uric acid crystals in the joints.
Excess uric acid in the bloodstream can crystallize into monosodium urate, which is deposited in articular cartilage, tendons, and tissues surrounding joints. Tophaceous gout occurs when deposits of monosodium urate deposits, also called tophi, increase in size. This usually occurs after several years of elevated uric acid levels and minor gout symptoms.
The main symptom of gout is severe joint pain. The pain is caused by crystals that form within the joint, making movement painful, as well as inflammation that occurs around the joint. Often the joint is so sensitive that even a very light touch can cause severe pain. Other possible symptoms include a low-grade fever, swelling, redness, and stiffness in the affected joints. Gout most often affects the big toe, but it can also affect the ankle, heel, or ball of the foot, or the knee, elbow, wrist, finger, or spine joints.
In people with tophaceous gout, symptoms increase in severity as monosodium urate deposits become larger. As the deposits increase in size, they begin to spread outside the joint, causing noticeable lumps under the skin. In advanced cases, the tophi can become so large that they break through the skin. Tophi are visible as white, chalky-looking nodes surrounded by reddened, inflamed skin.
Complications of tophaceous gout can become serious if the nodes are not treated. Gout itself, as well as the development of tophi, can severely reduce mobility due to joint pain and stiffness. Also, when tophi break through the surface of the skin, there is a risk that they will become infected or ulcerate. The infection can lead to a life-threatening illness called septicemia, in which bacteria enter the bloodstream.
Treatment of tophaceous gout includes anti-inflammatory medications as well as medications to help control pain and lower uric acid levels in the blood. If uric acid levels can be brought down to a consistently low level, crystallized monosodium urate eventually begins to dissolve, reducing the size of tophi nodes and helping to relieve symptoms. Dietary changes, including reducing intake of purine-rich foods, are also helpful. If these treatments are not enough to stop or reverse the progress of the disease, surgery may be required to remove the tophi.