How Are Gout Crystals Removed?

If you’ve been diagnosed with gout, you may wonder, can gout be removed? Gout can be an extremely painful condition. A commonf inflammatory arthritis that affects the joints, most often the big toe, gout is caused by a buildup of uric acid in the body.

With proper treatment you may be able to reduce the number of gout crystals in your joints, however, sometimes gout tophi can interfere with your daily life. Gout removal may then become necessary. When this occurs, you may need treatment such as steroids, debridement, or full surgical removal in order to relieve pain, avoid infection, or restore mobility.

Gout tophi are masses of monosodium urate crystals that have deposited around a joint. These tophi usually occur over time after several gout attacks. In the hands, they look like bulbous lumps that have attached themselves to the joints.

You may not experience much pain or disability at first, but the tophi, if left untreated, can continue to grow to the point that it is difficult to carry out daily functions. Untreated tophi and gout can cause joint instability and limit your range of motion. Tophi can also cause bone erosions and complications such as ulcerations and infections.

Normally, your body processes the purines from foods like red meat, dried beans, and alcohol and the uric acid that results from the breakdown dissolves in the blood. The uric acid then passes through the kidneys and out of the body in urine.

With gout, however, the uric acid can accumulate in the body and form needle-like crystals that deposit in the joints and cause pain. These crystals are called gout or uric acid crystals.

While early diagnosis is key to beginning a proper treatment plan for gout, which can include medications and lifestyle changes, untreated gout or gout that has progressed can become chronic tophaceous gout.

Tophaceous gout results from gout crystals, or monosodium urate crystals, gathering around a joint or several joints. When this occurs, nodules can form. These nodules can be quite painful and interfere with your daily activities.

Often the nodule can be confused with rheumatoid nodules, but a healthcare provider's examination and a biopsy of the fluid in the nodule can help determine whether or not the mass is a gouty tophus.

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Gouty tophi are a manifestation of long-term untreated high levels of uric acid in the blood, or hyperuricemia. Treating gout and therefore tophi requires a comprehensive plan. Your healthcare provider may prescribe medication and will also talk to you about lifestyle modifications.

Eating a healthy diet, losing weight, limiting alcohol, and adjusting your diet to include fewer purine-rich foods like red meat and organ meat are factors that can help control gout. Your healthcare provider may also prescribe a therapy to lower the amount of uric acid in your blood using drugs such as allopurinol, febuxostat and pegloticase.

The object of treatment is to maintain your health and quality of life. Staying active and seeking guidance for the types of activity that are best for you and your joints can also help you live well with gout.

If you have gout tophi that do not decrease in size and continue to cause pain and disability even with treatment, your healthcare provider may suggest surgery.

If you experience a lack of improvement after more conservative treatments, surgery may be necessary. There are multiple instances when surgery for gout tophi is considered.

You may need surgery for impaired function, nerve compression, infection, joint instability, significant pain, and skin ulceration. Ulcerated gouty tophi are susceptible to infections. Surgery is considered when sepsis or infection occurs.

If there is deformation or inability to move the joint properly, surgical intervention becomes inevitable. It is most common to have surgery when mechanical problems result from the tophi. Sometimes, surgery may be indicated for pain.

There are several surgical options for gout tophi that you may discuss with your healthcare provider:

Living with the pain from your gout can be difficult. When pain affects your daily life, it is not uncommon to feel a bit hopeless. If you are feeling overwhelmed, it is important to talk to your healthcare provider. Following your healthcare provider's treatment plan and understanding the options you have for gout removal can help you regain a sense of control.

Surgery itself can be a scary thing but rest assured that most people who have gout removal surgery feel much better afterward and their prognosis is good.

MedlinePlus. Tophi gout in hand.

Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective - A review. J Adv Res. 2017;8(5):495-511. doi:10.1016/j.jare.2017.04.008

Sapkota S, Kolade V, Brit M. Gouty tophi. J Community Hosp Intern Med Perspect. 2014;4(1):22920. doi:10.3402/jchimp.v4.22920

Xu J, Zhu Z, Zhang W. Clinical characteristics of infectious ulceration over tophi in patients with gout. J Int Med Res. 2018;46(6):2258-2264. doi:10.1177/0300060518761303

Centers for Disease Control and Prevention. Gout.

Słowińska I, Słowiński R, Rutkowska-Sak L. Tophi - surgical treatment. Reumatologia. 2016;54(5):267-272. doi:10.5114/reum.2016.63819

Öztürk R, Atalay İB, Bulut EK, Beltir G, Yılmaz S, Güngör BŞ. Place of orthopedic surgery in gout. Eur J Rheumatol. 2019;6(4):212-215. doi:10.5152/eurjrheum.2019.19060

Lee SS, Sun IF, Lu YM, Chang KP, Lai CS, Lin SD. Surgical treatment of the chronic tophaceous deformity in upper extremities - the shaving technique. J Plast Reconstr Aesthet Surg. 2009 May;62(5):669-74. doi:10.1016/j.bjps.2007.12.021

Kim Y, Park E, Lee H, Koh Y. First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis. Orthopedics. 2014;37(2):e141-e147. doi:10.3928/01477447-20140124-15

Chang-Fu Kuo, I-Jun Chou, Lai-Chu See, Jung-Sheng Chen, Kuang-Hui Yu, Shue-Fen Luo, Ao-Ho Hsieh, Weiya Zhang, Michael Doherty. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology. 2018;57(12):2129–2139. doi:10.1093/rheumatology/key212

Gout | Arthritis | CDC. Cdc.gov. https://www.cdc.gov/arthritis/basics/gout.html.

Topics H. Gout | Gouty Arthritis | MedlinePlus. Medlineplus.gov. https://medlineplus.gov/gout.html.