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Studies have also shown that, if uric acid lowering treatment is withdrawn, tophi and acute gout attacks will return.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 share your opinions and questions in the discussion below.
Latest information on tophi is at http://www.goutpal.com/gout-symptoms/tophi/ or search for tophi