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How are gout crystals removed?

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If you have been diagnosed with drop, you may be wondering if gout can be suppressed? Gout can be a extremely painful condition. A common inflammatory arthritis that affects the joints, most commonly the big toe, gout is caused by a buildup of Uric acid in the body.

With proper treatment you may be able to reduce the number of gout crystals in your joints, however, sometimes gout tophi can interfere with your daily life. Elimination of gout may then become necessary. When this happens, you may need treatment such as steroids, debridement, or complete surgical removal in order to relieve pain, prevent infection, or restore mobility.

What are Tophi gout?

Gouty tophi are masses of monosodium urate crystals that are deposited around a joint. These tophi usually occur over time after several gout attacks. In the hands, they look like bulbous pieces that have attached themselves to the joints.

You may not feel much pain or disability at first, but tophi, if left untreated, can continue to develop to the point that it is difficult to complete daily tasks. Untreated tophi and gout can cause joint instability and limit your range of motion. Tophi can also cause bone erosions and complications such as ulcerations and infections.

How is Tophi developing?

Normally, your body processes the purines from foods like red meat, dried beans, and alcohol and the resulting uric acid from the breakdown dissolves in the blood. Uric acid then passes through the kidneys and out of the body in the urine.

With gout, however, uric acid can build up in the body and form needle-like crystals that deposit in the joints and cause pain. These crystals are called gout or uric acid crystals.

While early diagnosis is essential to begin an appropriate treatment plan for gout, which can include medication and lifestyle changes, untreated gout or gout that has progressed can develop into chronic tophaceae.

Tophaceae gout results from gout crystals, or monosodium urate crystals, which gather around one or more joints. When this happens, nodules can form. These nodules can be very painful and interfere with your daily activities.

Often times, the nodule can be mistaken for rheumatoid nodules, but examining a healthcare professional and taking a biopsy of the fluid in the nodule can help determine whether or not the lump is gouty tophus.

Gout Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

How are tophi treated?

Gouty tophi is a manifestation of long-term, untreated high levels of uric acid in the blood, or hyperuricemia. The treatment of gout and therefore tophi requires a comprehensive plan. Your healthcare professional can prescribe medications for you and will talk to you about lifestyle changes as well.

Eat healthy, lose weight, limit alcohol and adjusting your diet to include fewer foods high in purines such as red meat and organ meats are factors that can help control gout. Your healthcare provider may also prescribe treatment for you to reduce the amount of uric acid in your blood by using medicines such as allopurinol, febuxostat and pegloticase.

The goal of treatment is to maintain your health and quality of life. Staying active and seeking tips for the types of activities that are best for you and your joints can also help you cope well with gout.

If you have gouty tophi that do not decrease in size and continue to cause pain and disability even with treatment, your health care provider may suggest surgery.

When is surgery considered?

If you see a lack of improvement after more conservative treatments, surgery may be necessary. There are several cases where surgery for tophi gout is considered.

You may need surgery for impaired function, nerve compression, infection, joint instability, severe pain, and skin ulceration. Ulcerated gouty tophi are susceptible to infection. Surgery is considered when sepsis or an infection occurs.??

If there is a deformity or an inability to properly move the joint, surgery becomes inevitable. It is more common to have surgery when mechanical problems result from tophi. Sometimes surgery may be indicated for the pain.??

What are the surgical options?

There are several surgical options for tophi gout that you can discuss with your healthcare professional:

  • Shaving technique: Intra-lesional shaving is done by making multiple small incisions in the skin to allow direct access to the tophic mass. Aspiration and irrigation are performed simultaneously to remove chalky deposits of sodium urate at the same time.
  • Complete surgical removal: Tophi can be completely excised and removed from the joint as much as possible without destroying surrounding tissue. Removal of gouty deposits and nodules also occurs at this time.
  • Joint fusion: If the joint is unstable and damaged by tophi, joint fusion may be recommended. The small joints will be fused together to limit movement and reduce pain.
  • Joint replacement: If gout tophi causes irreversible damage to the joint, you may need a total joint replacement, such as knee or hip replacement, to restore function and reduce pain.

A word from Verywell

Living with the pain of gout can be difficult. When pain affects your daily life, it’s not uncommon to feel a little hopeless. If you are feeling overwhelmed, it is important to talk to your healthcare professional. Following your healthcare provider’s treatment plan and understanding your gout options can help you regain a sense of control.

The surgery itself can be a scary thing, but rest assured that most people who have gout removal surgery feel much better afterwards and have a good prognosis.

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