All patients are different, but advanced gout often leads to disability. Development of tophi occurs in the majority of patients over time. Tophi are nodular masses of uric acid crystals, which are deposited in joints, cartilage, bones and different soft tissue areas of the body. Tophi break through the skin and appear as white or yellowish-white, chalky nodules. The higher your uric acid and the longer you’ve had symptoms, the more likely you are to have tophi.
Tophi can limit your ability function normally, particularly if they are in the smaller extremities – hands and feet – because they interfere with tendons and cause bone erosion. In 10-15 percent of patients, tophi are severe and disfiguring. Some patients need specialized shoes. In patients with extreme cases, they have needed finger or toe amputations.
There is a reported decline in quality of life when gout is uncontrolled.
Gout not only takes a physical toll on the body, but it also takes a mental toll.
Where is Tophi Commonly Found?
Even though tophi are most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, vocal cords, or even against the spinal cord.
Many patients have a lot of guilt associated with their disease – stemming from the myth that gout is self-inflicted from poor dietary and lifestyle habits. Patients also suffer from participating in life’s activities less and are less independent due to difficult mobility and embarrassment over unattractive tophi. If lack of mobility affects work productivity, this reduces self-esteem. In older and retired patients, this very difficult form of arthritis often limits participation in social and leisure activities or hobbies. All of this can lead to isolation, and in some cases depression.
When patients hear there is treatment to eliminate tophi, that is great, uplifting news for them.