Tophi And Allopurinol

February 17, 2007 in Gout Remedies Forum For Gout Treatment

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Tophi Knee And ElbowGout 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Studies have also shown that, if uric acid lowering treatment is withdrawn, tophi and acute gout attacks will return.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 share your opinions and questions in the discussion below.

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28 responses to Tophi And Allopurinol

  1. Gout was found in system about 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 medication. I will try to send in some reports as to how well this is working and how much the tophi is improving. 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

  2. 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?

  3. 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.

  4. 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.

  5. 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.

  6. 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.

    • alan said on May 31, 2009

      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!!!!

  7. 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

  8. 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?

  9. 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.

  10. i have had tophi on my foot and finger went on allopurinol 7 months ago.had abad couple of months with attacks,now stopped and tophi gone stick with allopurinol 300mg

  11. I’ve been on allopurinol for about 10 years with side effect of being able to run again.

  12. Hi my name is Vincent,
    I’m 21 years old and suffering from gout for 3 years. :(
    (suffering it on both toes) I’m seeing small white lumps form on my toes ( I’m guessing its tophi)
    I been talking 300mg Allopurinol for a couple weeks now and its been working well. When, I was 18 I dismissed this a small pain in my feet. Now its ruining my life and job. Really need some helpful suggestions from you guys. PLEASE!!

    • Hi Vincent,

      When you say that the allopurinol is working well, what do you mean? Has it already lowered your uric acid to a safe level?

      If it has, the tophi should soon begin to shrink, and most should disappear completely, but sometimes they persist.

      The best suggestion from me is to keep monitoring uric acid, and get it as low as you can – allopurinol can be increased up to 800mg per day if necessary.

      Come back with some numbers to get clearer advice, and also read my allopurinol pages.

  13. Hey GoutPal,

    My uric acid level has been lowered to 5.9 ever since using allopurinol for 2 weeks. It has been as high as 6.5 three or four months ago. Iwas wondering what are the long term effects of using allopurinol for the rest of your life? And secondly, do you know any NSAID that can be used on a daily basis? ( instead of Indomethcin)

    • The long term effects of allopurinol are that you stop getting any more gout attacks (after the first few months, when all old uric acid deposits and tophi have dissolved).

      There are no ill effects of allopurinol (once you have determined that you are not allergic to it). However, there is research to suggest that, if you are monitoring uric acid levels properly, allopurinol need only be taken for 5 years, then take an ‘allopurinol holiday’ for a few months, until uric acid levels start to rise again. I recommend monthly testing during the time you stop taking allopurinol.

      As far as I am aware risks of heart disease and possibly other conditions rise with all NSAIDs when taken for a long time, but there is no reason for them if you use allopurinol to dissolve all tophi and other urate deposits.

      • Hi Gout Pal,

        I’m really in deep concern right now its my 3rd week of allopurinol and I ‘ve been taking indomethacin. ( both medications in relatively smalls meals) Two consecutive days later, I been getting progressive headaches. I also felt like vomitting but nothing came out. I notice white substances (maybe uric acid) on my skin around my throat. (similar to the infected joints)

        Please respond A.S.A.P

        • Get to your doctor or Emergency Room immediately.

          I am an amateur gout advisor. I can’t see your symptoms. I have no medical training.

          Why are you messing around and endangering your health in this way?

  14. I diagnosed myself with gout in 2008 and had to beg the NP to test uric acid levels. I had injured my knee and gout set in. I did have an MRI which revealed a torn meniscus and some other soft tissue injury. But gout is opportunistic. My uric acid was 10.5. Even then when the NP handed me off to an MD, then to a Rheum, they suspected I had RA. The Rheum had me take some serious meds….Plaquenil, Sulfasalazine, then Methotrexate. I had reactions to all of them. He still didn’t think I had gout because my mother had both RA and Sjogren’s. I also don’t fit the usual profile. I’m female, 5’7″, weigh 105 lbs, have an HDL of 104, no diabetes, don’t smoke, rarely drink. I do take Lasix for idiopathic edema but even as I asked him about that precipitating gout, he didn’t think so. So I suffered through many gout attacks with no meds. He finally thought I could try the colchicine to prevent flares. At one point my serum uric acid was 13! I changed Rheums, he ran a huge battery of tests to say I don’t have RA. I had surgery in 5/2010 for a lump in the finger pad of my right index finger…biopsy revealed uric acid deposits. Finally the first confirmation. But since then tophi appear practically overnight in my hands. 6 months ago I started Probenicid. A month ago my uric acid was 4.2. I’ve had 3 new tophi appear in the last week. My new Rheum decided I was an underexcreter. I am to start Allopurinol next week. I’m hoping it doesn’t work so I can try Krystexxa, which my Rheum was involve with the clinical trials. That is supposed to get rid of tophi super fast. My nice graceful hands are becoming gnarly looking and I am sick of tophaceous deposits! I’ll report if the Allopurinol works.

  15. This discussion is now closed. If you have pictures of tophi, please share your gouty tophi photographs.

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