Tophaceous Gout

Tophaceous gout may form early in the disease, as early as three years after the first attack of gout, or as late as forty years after the first attack of gout.The progressive build-up of uric acid in the system, and the inability to excrete the excess urates results in the excess urates forming depolsits (tophis) in cartilage, synovial membranes, tendons and soft tissue.

The most common site for tophi to be found is in the helix of the ear, although the tophaceous swelling may appear in fingers, hands, knees, elbows and achilles tendon.The distribution of tophi is similar to that of rheumatoid nodules, the widespread use of allopurinol has resulted in a far less common appearance of tophi. Depending on the tophi site, they may considerably inhibit movement, and eventually cause gross deformities of the hands and feet.The tophi do not cause pain, however, they do produce stiffness and aching of the affacted joint, carpal tunnel syndrome may be caused from these tophaceous deposits.Initially the tophi may appear as irregular swellings, however with increased chronicity and if left untreated they will eventually discharge through the skin.

Reference:Forbes,Charles D,&Jackson,William F Color Atlas and Text of Clinical Medicine 2nd edition Published Mosby-Wolf.1997.