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Gout is a disease which causes sudden burning pain in the joints, due to inflammation. The primary 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 uric acid metabolism are the main causes of this condition. Tophaceous gout, also called chronic gout, occurs in people with long-term elevated uric acid levels, which leads to the formation of large crystals of uric acid in joints.
Excess uric acid in the bloodstream can crystallize into monosodium urate, which is deposited on joint cartilage, tendons, and tissues surrounding the joints. Tophaceous gout occurs as deposits of monosodium urate deposits, also called tophi, increase in size. This usually happens after several years of elevated uric acid levels and minor gout symptoms.
The primary symptom of gout is the severe pain in the joints. The pain is caused by the crystals that form inside the joint, which makes movement painful, as well as by inflammation that occurs around the joint. Often the joint is so tender that even a very slight touch can cause very severe pain. Other possible symptoms include low fever, swelling, redness, and stiffness in the affected joints. Gout most often affects the big toe of the foot, but may also affect the ankle, heel, or instep of the foot, or joints in the knee, elbow, wrist, fingers, or spine.
In people with tophaceous gout, symptoms increase in severity as the deposits of monosodium urate become larger. As the deposits increase in size, they begin to extend outside the joint, causing noticeable lumps beneath the skin. In advanced cases, the tophi can become so large that they break through the skin. The tophi are visible as white chalky-looking nodes surrounded by reddened and inflamed skin.
Complications of tophaceous gout may become serious if the nodes are not treated. Gout itself, as well as tophi development, can severely reduce mobility due to pain and stiffness in joints. In addition, when tophi break through the surface of the skin, there is a risk they may become infected or ulcerated. Infection may lead to a potentially fatal illness called septicemia, in which bacteria enter the bloodstream.
Tophaceous gout treatment includes anti-inflammatory medications as well as drugs to help manage pain and lower blood levels of uric acid. If uric acid levels can be reduced to a consistently low level, the crystallized monosodium urate eventually begins to dissolve, reducing the size of tophi nodes and helping to alleviate symptoms. Dietary changes, including reducing the intake of foods high in purine, are also useful. If these treatments are not enough to halt or reverse the progress of the disease, surgery to remove tophi may be required.
There is a new drug on the horizon that might help treat severe gout.
The medication involves an enzyme that changes uric acid into a water soluble substance that can be than easily eliminated from the system.