June 16, 2009 at 11:30 pm #2887Al O’PurinolParticipant
[admin: This draining tophi topic is now closed. See treatment for gout to remove tophi for full details of how to get rid of tophi. If you still have questions about draining tophi, please start a new topic.]
I have a small tophi on my left big toe joint. I WebMD'ed for info, and found that it is probably indicative of advanced gout. Looking back, I have had one unexplained swelling of my big toe. I am 59, not overweight, female, eat a good diet, not rich in meats. In the past I have used alcohol to excess, but currently do not drink.
I have a $6000 deductible on my health insurance so can't afford health care. Should I lance the tophi or leave it alone? Does the presence of it mean that I will inevitably advance into more chronic phases of the disease?October 12, 2009 at 6:43 pm #6062
This question was posted back in June but I think it’s a subject that’s hard to get useful data/info about. I have a large tophi on my left toe joint for some weeks now. (Unlike you, Gail, I have been diagnosed with gouty arthritis.) A portion of it has been draining and there is what seems to be a white plug which goes very deep, possibly into the joint it’s self, and I’ve been trying to find info about the proper care of this and if it will ever heel or will I be left with a big hole where this tophi is. So far no luck.October 12, 2009 at 6:53 pm #6063
No sooner than I make he above post and then come across this, http://ndt.oxfordjournals.org/…..l/20/2/431October 13, 2009 at 3:28 am #6065
Interesting! This is a potent drug against tophi , though expensive and not easy to administer.
Following your links got me this excellent hyperuricemia overview:
which includes the snippet..
Although allopurinol is usually well tolerated, it may cause adverse effects that need a discontinuous use, in about 20% of patients.  Oxipurinol inhibits xanthine oxidase too and is an alternative to allopurinol, but an allergy to allopurinol is a contraindication to its use, owing to cross-allergies between them. 
I didn't realise reaction to AlloP was so common.
However this article qoutes it , with alkalisation- as the normal approach to tophi.October 13, 2009 at 7:14 am #6068
Nice find, Trev. I’ll have to bring this drug up with my specialist at my next visit.October 13, 2009 at 12:03 pm #6071
This is a whole new can of worms.
I have OFTEN thought wouldn't it be nice to introduce the enzyme that man was lacking that converted uric acid to alllantoin and allowed easy excretion. But then introducing enzymes that evolution has eliminated (presumably for a good reason) might have some red flags.
In the case pf Peg-Uricase…it's allowed in Europe but the U.S. FDA has said NO (this year if I'm not mistaken.)
In any case, good bad or indifferent, uricase will not attack tophi at all, just convert uric acid in the blood to a more excretable form. In that respect, it will not likely battle tophi any better than allopurinol, febuxostat, probenecid or sulfinpyrazone. Tophi are walled off by scar-like tissue as a defense mechanism. Huge tophi are best removed by surgery for this very reason.
I have drained a tophus from my thumb. myself but I would be hesitant to recommend it. I am contemplating doing the same thing with my little finger but only becasue the tophus looks so very close to the skin surface and the tophus is small.
Remember though, any intervention is a SURGICAL intervention, whether you do it or a doctor does it, and one must think of danger of infection, scarring, sterile environment, antibiotic covering, etc.
In fact even if a tophus opened and drained spontaneously I would be very careful to keep it scrupulaously clean, disinfected, properly gauzed etc. just like any other wound. I guess the only thing I would do with a tophus that I wouldn't do with a wound is to make sure it keeps open and draining till all the yucccchhhh is out.
I was extremely and amazingly successful with my thumb. But remember, your doctor can PROBABLY do this better than you can although most probably WON'T.October 13, 2009 at 2:43 pm #6076
The article mentions non-sense changes (breaks) to human DNA way back. I suppose it's possible that in a world where fruit and berries became extremely short supply the only effective survivors genetically would be those keeping back extra anti -oxidants ie: in the form of UA!
This could indeed tip the balance in overall health level after a climatic catastrophe- especially as we're looking at a time when human life span was barely more than reproducive years + a few more if you were lucky -and not male.
Makes sense, when you think about it.Females don't usually suffer from gout till after the menopause.
People just weren't living long enough to get gout- now we pay back our forebears when the world is well overcrowded …aint justice wonderful?
BTW: This drug seems mainly of use after cancer therapy has caused a surge in UA.October 13, 2009 at 4:07 pm #6081
Post edited 9:33 am – October 13, 2009 by trev
Although allopurinol is usually well tolerated, it may cause adverse effects that need a discontinuous use, in about 20% of patients.
I'm a complete newbie, does this % sound accurate? I've never heard of adverse AP side effects being 20%. So what thats saying is that AP cannot be used in 1 out of every 5 people. Just seems very high to meOctober 13, 2009 at 5:11 pm #6085
Well CJ, the report (looked high level) was from italy. Maybe they have better monitoring there- or maybe it's just kept quiet eleswhere.
I have noticed that overall , the drug co's generally underestimate the reactions to drugs ( on labels). Over time when people see others getting similar reactions I think they tend to report it it more- but not necessarily to the proper authorities. I've seen drugs called up as having say, a 5% side effect reported generally (online) as being 50- 100% incidence in practice- but this probably at varied levels to be fair. Risk v. Benefit again.
Quite a few accounts on this forum where side effects have played a part. Yes- about 10% + certainly.
The more useful a drug- the more side effects, often enough!October 14, 2009 at 6:17 pm #6098
I see numbers indicating discontinuation of allopurinol due to side effects in the range of 3% or less.
But probably FAR higher numbers represent people who just DON'T want to take a drug forever. And these people have more gout attacks and go back on and then off…October 14, 2009 at 7:38 pm #6102
Instead of getting smaller, with cholcicine 0.6mg twice a day, my tophi is growing from my big toe joint back along the side of my foot and it still has a spot where it is draining. I’m going to call the specialist tomorrow and see if she will let me take the colchicine four times a day and try to get a handle on disolving the crystals. From research I’ve done this will probably mean diarhea as a side effect but I gotta do something.October 15, 2009 at 9:25 am #6103
If you're in the middle of an attack you'll probably need much more than 4…Took me I think 10-12 in a day to finally rid myself of major pain. Problem is I dont think any Dr will tell you to take that many. Just my opinionOctober 15, 2009 at 9:26 am #6105
And to clarify on the increased dosage, that is for 1 day only and then stop taking it al together. This is not a dosage you take everydayOctober 15, 2009 at 1:29 pm #6108
@Richard Bell : Colchicine four times a day and try to get a handle on disolving the crystals
Bear in mind that the Colch. is to help reduce inflammation in attacks &/or to offset the effects of UA reduction drugs working, as they may well should, when causing flares.
Generally Colch. is at the one to two per day for prophalaxis, and not best taken permanently -or up to 8 [or more -for some brave types] over the course of one day, taken at clear intervals, as short blitz on the attacks' first 'assault phase' -as the immune system cranks up. it will be interesting to see what your medic advises on the tophi problem.October 15, 2009 at 5:44 pm #6110
Colchicine will NOT reduce tophi, nor will it lower uric acid. It is STRICTLY for pain relief in aborting an acute attack.
Richard, try to encourage the draining, with massage and hot soaks if not too painful and make sure that your specialist takes a sample of the fluid to make sure it is urate. The more you get out before it seals over the better for you in the long run.
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