Tophi And Allopurinol
Posted by GoutPal in Gout, Gout Cures, tags: allopurinol, tophi, tophus
Gout brings strange swellings to elbows, knees, hands and ears. Uric acid crystals build up as lumps outside the joints. Each lump is called a tophus. You usually get several tophi – a stage of gout called tophaceous gout.
A reader is anxious to hear your experience of tophi and allopurinol, but first some background.
When tophi grow near the joints, particularly on the fingers, you might need surgery to remove them. Tophi also need to be removed if they break through the skin and risk causing infection.
The alternative to surgery is to lower uric acid low enough so that crystals in the tophi, and in the joints, dissolve. In the study, “Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout”, the authors conclude:
Serum urate levels should be lowered enough to promote dissolution of urate deposits in patients with tophaceous gout
This can take many months, even years. In the study, “Excellent response to the clinical treatment of tophaceous gout”, the authors report good progress after 30 months.
Studies have also shown that, if uric acid lowering treatment is withdrawn, tophi and acute gout attacks will return. Until recently, it was thought that medication such as allopurinol should continue for life, even after tophi had dissolved and acute gout attacks had stopped. A recent study suggests that, if the treatment to lower uric acid is done correctly, then drugs may be suspended for a time. In “Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy: a prospective study.”, the authors conclude that:
These results suggest that 5-year intermittent, instead of life-long, ULT [Uric acid or Urate Lowering Treatment] could be offered to patients with good serum urate control during ULT
In the first two studies I’ve mentioned, allopurinol was used to reduce uric acid levels. Benzbromarone was also used, and I’ll report more details about this drug in a separate post.
This brings me back to my reader’s quest for information about tophi and allopurinol. Do you have any experiences of taking allopurinol when you had tophi? Please tell me about them. As always, you can use my contact form or comment below. Even better, why not start a discussion in my gout treatment forum.
Entries (RSS)
Following some more messages, I’ve started my own allopurinol topic in the gout treatment forum.
I’ve announced it here in this gout blog today.
This is about allopurinol, rather than tophi. If you want to discuss tophi, a tophus, or tophaceous gout, you can add your comment below, or start a new discussion in the forum.
Gout was found in system abouth 25 years ago and after treatment was given for about two years it was determined that my gout was cured. But 25 years later I was found to still have gout the tophi began to show around my elbows and in my finger joints. I an now taking the allopurinol just started taking it this week. along with some other medicaton. I will try to send in some reports as to how well this is working and how much the tophi is improvemening. I have read all the information you provided and found it to be great help and gives good advise on the cause and treatment of this problem. It is good to know of a site that can help with such medical problems Thanks for you insite
Thank you for your comments. I look forward to hearing how you get on with the allopurinol.
Have you been advised to take any anti-inflammatory medication along with the allopurinol to reduce the effects of gout flares?
I have gout and tophi for over 25 years on my knee. I was on Alpurall but was annemic and start to have liver problems. I was removed from it for about a year. I have found more tophi and my gout went crazy. I went on Probeamed and now back on allpurnal for about a month. (as you see it has afected my speeling) I have had neck pain for years form a lump on the side of neck. I,m not sure what it is but I would guess a tophi. My new Doctor is great but I know that it will take time for the drugs to work and they may never remove the tophi, I will try to keep you inform.
Hi L Clark,
Yes, please keep in touch about your progress. I hope you get the right treatment to maintain uric acid below 6mg/dL. You need regular blood tests to ensure this is happening.
If it is, tophi will eventually dissolve, but it can take months, even years.
I developed a tophus is my big toe joint three years ago (I did not even realize that I had gout until then). After a friend of mine told me that oral chelation (EDTA) had helped him, I started using it last week. The tophus seems to be getting smaller. I will keep you updated.
I have had tophacious gout for years. Lately frequent episodes in both feet. At the behest of my podiatrist I madwe an appointment with and arthritis specialist. I was always reluctant to start allopurinol, but finally gave in. In only 5 days my big toe joints as less enlarged and the usual pain that I had in my foot joints behind my other toes has disappeared. I feel like a new person and suddenly the discomfort that I suffered in my both feet for so many years is almost all gone. I am a very objective person and do not believe that the improvement is psychological as I did not know that allopurinol could dissolve the existing tophus deposits that I had. Also, I hate to take any medications, but was so worn down from all the gout pain that I finally gave in.
Needless to say I am elated at the rapid results I have already seen from the allopurinol.
Hi aaron…so happy for you! i am about in the same boat as you..i am scared of the side effects of allopurinol….do you know how often they present themselves? i have a very large left elbow and am seeing a surgeon to talk about cleaning it out….any info on that surgery??
thanks much and i wish you only good health!!!!
Hi there ,
i have tophi in both elbows and will have surgery next week 2009/07/015
i would like to know more about the surgery , i will have both arms done
i have tried and am busy with allupuronol tablets , the docter prescibed 300mg and at first i could only get to day 4 and then could not walk for days because of the gout attack . Ihave started with it again , but in lower mg untill i can get to the prescribed mg’s , so far i have had one attack but the elbows are still sore and the lumps even bigger , but i have only been using the tablets for the past 3 months
regards
george
Hi George, I’m a 41 year old male, diagnosed with gout approx 12 years ago. 3 years ago my left elbow became very swollen, inflamed etc. at first my gp queried an infected bursar but later told me it was a tophi. Although the discomfort got easier, the swelling never really went away. I was tried on Allopurinol but after a few days had a reaction and i stopped taking them. 2 weeks ago, my elbow became very inflamed and more swollen than ever. Went to gp who said it wasn’t infected and suggested i try Allopurinol again. The following day, my elbow burst and large amounts of a gooey toothpaste like substance was oozing from it. Went back to gp who took a swab which showed infection, therefore needed antibiotics. My gp advised against surgery but said if the Allopurinol didn’t suit this time, I would be referred to a rheumatologist. I’ve been having my elbow packed and dressed for the last 10 days and although it has improved, it still isn’t right. Have to see the gp again Friday. Have they told you what your surgery entails.
Dean, what is your progress with this tophi?
Sounds a nasty add on to gout which, fortunately doean’t often get as nasty as your case.
You do seem to have gone suddenly quiet…
- Hopefully this is due to problem resolution?
HI
DEAN
I WAS SUPPOST TO HAVE SURGERY IN JULY 2009 , BUT COULD NOT DUE TO THE POOR FUNDED STATE HOSPITALS IN OUR COUNTRY , THE HOSPITAL HAD NO BEDS AVAILABLE ( PLEASE DON’T HAVE GOUT WHEN YOU DON’T HAVE MEDICAL AID !!) . I HAD TO WAIT 3MONTHS AGAIN TO SEE AN DOCTOR AT THE SAME HOSPITAL AND SUDDENLY HE SAYS THAT TOPHI COULD NOT BE REMOVED WITHOUT HAVING SERIOUS INFECTIONS AND COMPLICATIONS.
I HAVE BEEN USING THE ALLOPURINOL FOR THE LAST 6 MONTHS WITH NO VISABLE SIGNS OF IMPROVEMENT
I HAVE AN APPOINTMENT WITH A RHEUMATOLOGIST NEXT WEEK AND WILL ENQUIRE ALL ABOUT THE GOOD AND THE BAD OF SURGERY . THE TOPHI ON BOTH MY ELBOWS FEEL ROCK HARD AND NOT SOFT AS IN THE BEGINNING WHEN IT APPEARED , I ALSO NOTICED A LUMP ON MY LEFT SMALL TOE , IT FEELS THE SAME
REGARDS
GEORGE
That sounds suspiciously like your dose of allopurinol is not high enough, though it could be that tophi have compacted to the point where the crystals simply cannot dissolve.
You should be having regular uric acid tests. What are your latest results?
Good day to all.
I am 40 years old and was diagnosed with gout at the age of 21. I have tophi in both my hands an elbows. I went for surgery about a year ago for the one elbow. After surgery a had an gout attack and lastedabout two weeks. Surgery just awakens the gout attacks. Te healing process on the lebow took me 3 months. Well needless to say the elbow has tophi again and well my advise to you guys are don’t go for surgery, it doen’s work. I took allupurinol for 5 years in the beginning and it really worked but it has been discontinued in the country where I stay and now after many years I cannot find it any more as the tophi has become worse.
Pleas let me know where it is possible to find or order Allupurinol 300mg.
I had no idea that there were countries where you could not get allopurinol.
What country are you in?
My Find A Rheumatologist page explains how you can find professional help throughout the world. Try that, and see if you cannot find a source for allopurinol or another uric acid lowering treatment.
Remember, uric acid lowering treatments are only any use if you get your uric acid level below 6mg/dL. You need regular tests, and possibly dosage adjustments, to make sure you stay below 6. If not, you are wasting your time.