Table of ContentsView AllTable of ContentsStages and ProgressionSymptomsCausesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Stages and Progression
Symptoms
Causes
Diagnosis
Treatment
Prevention
Goutis a type ofinflammatory arthritisthat affects over 9 million American adults.It results fromhyperuricemia(high uric acid levels) in the body. People with chronic gout may develop tophaceous gout because uric acid levels in the blood stay too high, causing more crystals to form around the joints.
Tophaceous gout can affect any joint or soft tissue area in the body. It can be painful and lead to damaged joints and disability. Fortunately, treatments are available to alleviate symptoms, minimize flares or flare-ups (when symptoms are present), and prevent disability.
This article will cover the four stages of gout, symptoms, causes, treatment, and more.
FG Trade / Getty Images
Tophaceous Gout: The Most Severe Form of Gout
Medical professionals divide gout into four stages or types, which help them predict how the disease may progress over time.
The four stages of gout are:
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
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Asymptomatic Hyperuricemia
Asymptomatic hyperuricemia is the beginning stage of gout. This is when uric acid builds up in the blood.
Uric acid occurs when the body breaks down substances calledpurines, produced in the body and found in certain foods and drinks. Eatinghigh-purine foodsand drinks (red meats, organ meats, seafood, shellfish, and alcohol) can contribute to high uric acid levels.
High levels of uric acid can occur if the body cannot rid itself of uric acid efficiently for various health reasons, includingkidney disease,diabetes, anunderactive thyroid, and the use ofdiuretics(water pills).
This early gout stage causes no joint pain, redness, or swelling. Even so,uric acid blood testswill be elevated. Uric acid forms into urate crystals and starts to collect in the joints.
High uric acid levels are not enough to diagnose gout. Many people with hyperuricemia never develop gout. According to a 2021Biomedicalsreport, only up to 36% of people with hyperuricemia will go on to develop gout.
Acute Gout
In the acute stage, sudden nighttime attacks calledflares(also called attacks or episodes) might occur. Symptoms of a gout flare include pain, redness, and joint swelling. The most commonly affected joints in this acute stage are the big toes, feet, ankles, and knees.
Your next attack may not occur for a few months or up to a year.If attacks are not properly managed, they become more severe and frequent and last much longer as time goes on.
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Intercritical Gout
Up to 75% of people with gout have a second flare within a year of the first flare, but it is possible to go years without another gout attack.The intercritical stage is an asymptomatic stage (producing or showing no symptoms) between gout flares. This is the time to start long-term treatment.
How to Treat a Gout Flare-Up
Chronic Tophaceous Gout
If tophi develop in thesmall joints of the fingers, the fingers may experience physical changes and limited movement.Joint damage and deformity will eventually occur if the tophi are in the bone and cartilage. Tophi under the skin can be painful and get infected.
Gout can become chronic (long-lasting), but this might take a decade or longer.Chronicity results from ongoinginflammationand recurrent attacks.
Fortunately, due to effective treatment options, chronic tophaceous gout is rare. But even if gout gets to this point, uric acid–lowering drugs can reduce your risk for complications and visible tophi.
Tophi in Gout
Tophaceous Gout Symptoms
Gout causes inflammation in and around the joints and the soft tissues near affected joints.
Inflammation leads to:
Chronic gout can lead to additional symptoms and problems. These include:
Gout alternates between periods of flare-ups, when symptoms are present, and periods of remission without symptoms.When you get a gout flare, it typically comes on suddenly (usually at night) and quickly worsens. It may take days or weeks to fully recover from a flare.
Chronic gout causes masses of uric acid (tophi) to form under the skin. The number of tophi present will vary based on location, size, and number.
Symptoms associated with tophi include:
Tophi can cause severe damage to joint and bone tissue. Joint swelling and nerve compression can also lead to breakage and drainage of uric acid crystals, which lead to infection in the affected joint or tissue area.
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What Causes Tophaceous Gout?
Gout occurs when uric acid levels in the blood are too high. Typically, the kidneys flush out uric acid through urine excretion. But sometimes, there is too much for the kidneys to filter out, and the excess uric acid builds up in the bloodstream.
When uric acid levels are high, some uric acid can be deposited as urate crystals in the joints. Yourimmune systemwill see urate crystals as foreign substances and activate aninflammatory response, which leads to swelling, pain, and other gout symptoms.
Some people are at a higher risk of developing gout due to risk factors that are either non-modifiable or modifiable.
Non-Modifiable vs. Modifiable Risk FactorsNon-modifiable risk factors, such as age, sex, family history, and ethnicity, cannot be changed to affect the possibility of developing a health condition, while modifiable ones can.Diet, smoking status, weight, and a sedentary lifestyle are examples of modifiable risk factors.
Non-Modifiable vs. Modifiable Risk Factors
Non-modifiable risk factors, such as age, sex, family history, and ethnicity, cannot be changed to affect the possibility of developing a health condition, while modifiable ones can.Diet, smoking status, weight, and a sedentary lifestyle are examples of modifiable risk factors.
Non-modifiable risk factors for gout include:
Modifiable risk factors related to gout include:
You may develop chronic tophaceous gout if your gout is untreated or not adequately managed.You might also be at risk if you have frequent and severe flares.
Ajoint aspiration testcan confirm a diagnosis of gout.In this test, the clinician uses a needle to drawsynovial fluidor a sample of the tophus deposit, which is then sent to a lab for examination.
Serum uric acid concentrations may support a diagnosis of gout, but hyperuricemia alone does not necessarily mean you have gout.The best time to confirm a diagnosis is during a gout attack. Microscopic examination of tophi deposits can confirm a diagnosis of chronic tophaceous gout.
Additional tests to confirm or rule out gout might include:
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How Is Tophaceous Gout Treated?
There is no cure for tophaceous gout, but the condition is manageable and treatable. It can be treated with medications, lifestyle modifications, and surgery as a last resort.
Medications
Medications to lower uric acid are recommended for the following people:
The American College of Rheumatology recommends starting these medicines during an acute flare rather than waiting until a flare has passed.
Uric acid–lowering medicines used in the treatment of gout include:
During flares, you can take over-the-counter (OTC)non-steroidal anti-inflammatory drugs(NSAIDs) to reduce gout symptoms and reduce pain. Your healthcare provider can also prescribe additional medicines to treat flares. These may include:
Lifestyle and Self-Care
Some lifestyle changes and self-care strategies may reduce tophaceous gout symptoms and prevent flare-ups, including:
Surgery
Surgery may be needed to treat tophaceous gout. This might be the case if tophi masses become infected, compress nerves, or cause damage or severe pain. You may need surgery to remove large or very painful tophi or repair damage from tophi.Most people will never need surgery to treat gout.
How to Remove Gout Crystals From the Joint
How to Prevent Tophaceous Gout
If you are overweight, losing weight may reduce your uric acid levels and your risk for future gout attacks.It can also relieve pressure on painful joints.
Physical activity can reduce pain and the potential for disability from gout. Low-to-moderate physical activity has been found to reduce uric levels.Aim for 150 minutes per week of moderate-intensity activity. Consider activities that are easy on the joints, such as walking and swimming.
You should eat a healthy diet, stay hydrated, and avoid foods high in purines. You should also limit alcohol and not smoke. While smoking doesn’t directly cause gout, research has found that cigarettes can increase uric acid levels, which can increase your risk for gout flares and complications like tophi.
How to Prevent Gout
Summary
Gout progression can be prevented and does not have to become chronic or cause tophi. Tell your healthcare provider if you experience more than two gout attacks a year, if gout attacks are severe, or if you notice lumps under your skin. Once tophaceous gout is identified, you can start treatments to get uric acid levels under control.
18 Sources
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