Tophus

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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W8MD medical weight loss NYC and sleep center NYC

Tophus
Tophus on the left metatarsophalangeal joint
Synonyms	Gouty tophus
Pronounce	N/A
Specialty	N/A
Symptoms	Joint pain, swelling, deformity
Complications	Joint destruction, ulceration, infection
Onset	Typically after years of hyperuricemia
Duration	Chronic
Types	N/A
Causes	Gout, hyperuricemia
Risks	High purine diet, alcohol consumption, obesity, renal insufficiency
Diagnosis	Physical examination, imaging studies, synovial fluid analysis
Differential diagnosis	Rheumatoid nodule, lipoma, epidermoid cyst
Prevention	Dietary modification, medication to lower uric acid levels
Treatment	Medication, surgery
Medication	Allopurinol, febuxostat, colchicine, nonsteroidal anti-inflammatory drugs
Prognosis	N/A
Frequency	Common in individuals with chronic gout
Deaths	N/A

Tophus is a deposition of subcutaneous deposition of uric acid seen in advanced gout.

Tophus achilles tendon

Symptoms

Chronic tophi gout cause joint deformity and limitation of motion in affected joints may occur if several attacks of gout occur each year.

Gouty tophus

Locations

Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. Deposits also can occur in the kidneys, leading to chronic renal failure.

Etiology

A tophus (Latin: "stone", plural tophi) is a deposit of monosodium urate crystals, in people with longstanding high levels of uric acid in the blood, a condition known as hyperuricemia.

Gouty tophi on the elbow

Clinical pearl

Tophi are pathognomonic for the disease gout.

Pathophysiology

Without treatment, tophi may develop on average about ten years after the onset of gout, although their first appearance can range from three to forty-two years.

Treatment

• When uric acid levels and gout symptoms are usually controlled with standard gout medicines such as colchicine or
• Medications that decrease the production of uric acid (e.g., allopurinol, febuxostat)
• Other medicines that increase uric acid elimination from the body through the kidneys such as probenecid) can also be used

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