Tophi or not tophi…

This topic contains 3 replies, has 2 voices, and was last updated by  Keith Taylor 3 years, 9 months ago.

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  • #22093

    DRS
    Participant

    Hi there

    I saw a new doctor last week after my latest rheumy moved on.

    This was for what I thought was a swollen bursa on my elbow (2cmx2cmx2.5xm roughly) not rock hard, but spongy hard (if you get my meaning). It came up over 24 hours after what I thought was a little itchy bite on my elbow.

    The doctor insists that there is no way a Tophi can be drained or aspirated? I’m not convinced as I’ve seen quite a bit on the web AND the doctor has already given me a shot of medication which is known to interfere with something else I have to take, which a nurse had to give him hell for (even though he insisted there should be no problem) – not great and I can feel the adverse effects right now, I can tell you. T

    Can anyone shed some light on the tophi issue? I’m worried this guy doesn’t know his onions…

    Thanks

    #22100

    Keith Taylor
    Participant

    Is this new guy also a rheumy? Normally, if you wanted a tophi draining, I’d recommend a rheumy over any other doctor. I have heard in the past of some rheumatologists that don’t understand gout, but I’m hoping they are a very rare breed.

    Without professional examination of your elbow, it’s impossible to know if draining is an option. It is certainly possible to get a large tophus on the elbow, cos I have one. But the spongy-hard stage that you describe was years ago. I do not believe I had a tophus at that stage, or maybe only a very small one. I think mine was bursitis caused by uric acid crystals affecting the bursa. When gouty swelling around the bursa disperses, then the bursa itself shrinks back to normal. Or at least it did in my case.

    Anyway, even if your elbow can be drained, the proper solution is to get uric acid under control. Otherwise, it will just keep flaring. Worse each time.

    It sounds like your doctor might not be very effective at advising you on the best uric acid lowering treatment. If you don’t have an option for a better doctor, then we’ll just have to educate this one. I can help you with a safe uric acid reduction plan, but what will you do about other health problems?

    #22108

    DRS
    Participant

    The bursitis is exactly what I said originally. According to this rheumy NO TOPHI CAN BE DRAINED. Yes, he’s a rheumy – I see other specialists otherwise so no worries there.

    I’m allergic to allopurinol – I’ve got a UA reduction plan (and I can move to febuxostat if needed), anything you’ve got to contribute would be great,thanks

    #22109

    Keith Taylor
    Participant

    How very strange. You know that tophi can be drained, I know that tophi can be drained, yet your rheumatologist say they can’t!

    In his defense, surgery in any form should always be a last resort, and the general advice is usually along the lines of “do not attempt draining or surgical removal of tophi unless they restrict mobility, or are likely to burst.” It is much safer to encourage tophi shrinking by lowering uric acid significantly below 5mg/dL.

    There is an interesting summary in “The last defence? Surgical aspects of gouty arthritis
    of hand and wrist” ( http://www.hkmj.org/system/files/hkm1112p480.pdf ). Though that article is from Hong Kong Medical Journal, it does cite several studies from American and British rheumatologists.

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