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Over the course of the least year a tophus has appeared on my left big toe on the cross joint beneath the toe nail. I now have pretty much zero movement in it in terms of bending the toe. I've achieved this after six years of being a gout sufferer. I've been on 300mg allopurinol now for the last three months an the lump seems to still be gradually increasing in size (very slowly). About six months ago I consulted a consultant surgeon in London who told me that the it was best to leave it be and that movement in the joint had gone permanently and that he would operate if it became painful to remove the tophi by sawing away the joint either side of the tophi and then re attaching the toe. My question is whether the allopurinol is likely to melt the tophi away in time, or whether it's best just to go for the op and get it done with asap. I get a little pain at present but I'm wondering if this is likely to increase? Or, is there any other alternative I should check out before going for an operation. All info as ever, enormously appreciated.
No expert but did you say that movement in the toe joint has gone away permanently? I assume it was due to Gout related damage? So in essence the Doc would be sawing off your non performing joint and performing a permanent bone fusion?
> My question is whether the allopurinol is likely to melt the tophi away in time
In time for what?
I am not sure if few months of AlloP will get rid of it very quickly. If you are not in pain then maybe give AlloP a try. If pain increases then you can take up the OP option.The Gout veterans here will soon chime in. Good luck and wishing you a speedy recovery.
Yes the bone fusion would appear to be what he was suggesting. I'm just wondering whether my course of allop is likely to reduce its size over time.
Peter
I was told by both the rheumatologist and GP that the tophus would dissolve by the use of Allopurinol. My Tophus like yours has increased in size during the treatment.
On my recent visit to a Podiatrist he reckoned that it was going to be a feature of my toe for life and I should be considering having shoes modified specially for the outcrop.
I understand that any operations on the fingers or toes can stand a good risk of infection and more chronic future arthritis and my GP is considering this as a very last course of action.
Great that you can take the Allo. You have won the lottery.
David
Thanks David.
Sounds as though we're pretty much in the same boat. I'm just trying to work out what is the best course of action in the long and short terms. The surgeon described it as a “simple procedure” but didn't mention anything about increased chances of arthritus. It's about the size of a baked bean now and I don't want it getting any bigger really.
Thanks for getting back to me.
I've got a painless 'baked bean' on R index finger, over a year now – but I'm not sure if it's UA related.
It goes down readily if pressed and comes back minutes later. More likely to be subcutaneous cyst- but what do yours do, when pressed firmly for some seconds?
It's rock hard with no give at all. I was told by the surgeon that it's filled with chalky white liquid which contains the crystals.
Peter,
1. Allopurinol will NOT considerably reduce that tophus. It is pretty much isolated from any effects of the bloodstream.
2. Do NOT let Dr. Sawbones do what he recommended. He is suggesting a procedure that is purely cosmetic. If you have no pain or motion now, after the surgery you will still have no motion but are likely to have more pain.
3. See someone else who can remove much of the tophus less drastically. I'm sure there's SOMEONE who doesn't have to remove your toe. Sounds like someone going in for spinal surgery needing to have his LEGS removed first.
4. Now here's a zip cure…I'd do it to myself but I don't know if I would recommend it to someone else: Perfoprate the tophus and see if it will drain. Given half the chance the body will rid itself of toxins. I drained a tophus the size of a small white bean or a large pea from my first thumb joint. Scary but a complete success.
Peter, can you post a picture of the ugly bugger? (The toe, not the doctor!)
Peter Cameron said:
I'll have a go – at the photograph first.
Yeah, would someone, please, be so kind and show us, ME, slightly disadvantaged, how to post a photo?
hans,
I'll get you started…it seems to have changed since last I looked, so fiddle with the green tree icon on the post reply.
It HAD been easy to upload from our computers but now it seems to want an internet link so it might require first uploading your image to something like photobucket.com to get a URL??????
When I hit the BROWSE, all I get are GP's choices, rather than my computer structure where I can find my own pics.????????????????
We need to wait for GP's help here…I think he changed something.
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