acute attack – what to do with tophi

[Tim]

Hi, this is all great information. And I really like the way you have written it.

I am having an acute attack of gout while I am temporarily living in Spain – I am Australian. I have a second toe which has nobby bits on the joint but in my 5 or 6 attacks over 12 years, has never been a problem. This time it has been really bad and some tophi came out.

A doctor I saw here squeezed some and put my on Artrinovo (indometacina) as well as antibiotics. The language problem means I don’t think i’ll see him again, but I am not sure what to do about the tophi. Should I be squeezing it out? It has heeled well but there is a large white blister like mark on my toe.

Thanks for your website.

[Keith Taylor]

Hi Tim,

Squeezing it out is probably the best thing you can do. Otherwise, it’s only going to harden into a solid lump that might cause you problems with footwear and walking. As your skin has burst, you need to be careful about infections.

Tophi are a clear sign that your gout is seriously out of control. This episode has damaged the largest organ in your body – your skin. The spread of uric acid crystals will not stop there. All organs are targets, except the brain. You’ve spotted the tophi in your toe, as it got large enough to see. Those in your kidneys, heart and other organs are growing every day.

As soon as you can, you need to get uric acid down to safe levels. Long term, that means no higher than 5mg/dL. For the first year, you should aim much lower. That should get rid of the microscopic tophi that are set to cause damage throughout your body, before they become noticeable.

[Author]

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