Gouty Arthritis

gouty tophus 1
gouty tophus 2
gouty tophus 6

These photos demonstrate an advanced case of gout.

Gout is a condition that can be very painful. It is caused by the body depositing excess amounts of uric acid (a normal metabolic by-product), into the body tissue, rather than being excreted in the urine by the kidneys.

Uric acid dissolves in the blood stream, but in the tissue it can crystallize. These microscopic crystals are deposited in the tissue, leading to redness, pain, and swelling. The most common location is the big toe joint, though it can occur in other areas. The classic symptoms are pain and swelling occurring at night (though not always), often with extreme sensitivity to movement of the joint. This so-called “gout attack” is sometimes associated with a large meal of rich food and/or alcohol consumption the night prior.

When multiple gout attacks occur over time in the same location, the uric acid crystals can form a white, pasty substance called “tophus.” In uncontrolled cases, this tophus can even erupt through the skin. In the photos seen here, the patient had a long-standing deposition of tophus where the obvious bulge is seen. This created a lot of discomfort in shoes and several gout attack episodes.

Attempts to remove this surgically are not so simple because the tophus infiltrates the normal tissue that surrounds the joint. The joint surface is also damaged, which can lead to chronic arthritis.

Blood tests may reveal a high level of circulating uric acid, but this is not always the case. If there is an excessive amount of uric acid in the blood, diet modification can help, but medication may be required.

Treatment of the painful gouty attack is focused on decreasing the inflammation and pain during movement of the affected area.