Reducing Tophi in Gout
If you’re like Bert Middleton, you have said to yourself, “Enough is enough! There must be something I can do to eliminate this gout! I don’t want to go through surgery to eliminate the tophi crystals and I want a permanent solution. I won’t stop until I find something!”
Bert discovered that gout was the result of an overly acidic internal environment and that he needed alkalinizing green drinks or alkaline water to restore the alkalinity to his body so that the uric acid levels could be lowered. He also learned that the recommended diet for gout is one that is a low purine diet. This means you can’t eat red meats, sardines and other high purine foods. You have to avoid alcohol too if you want gout to go bye-bye once and for all. Bert lived through it all – and ended up with three excruciatingly painful surgeries for gout tophi before he found the answer.
Keys to Reducing Tophi in Gout
Gout, as defined by The Merck Manual, is “a recurrent acute or chronic arthritis of peripheral joints that results from deposition in and about the joints and tendons of monosodium urate crystals”, caused by elevated uric acid levels in the blood. Acute episodes of gout occur when the precipitation of these crystals into the joint causes an inflammatory response. When these crystals build up due to repeated attacks of acute arthritis they eventually lead to chronic arthritis and the formation of large, hard nodules known as tophi. (2) Gout generally forms initially in the peripheral joints and most often in only one joint at a time. Classically the joint of the big toe is most affected, but it can affect other joints as well, and often does in more chronic cases.
Tophi present as lumps or hard nodules under the skin in the area around joints or cartilage being affected. They do not typically appear until 10 years or more after the first gout attack, in what is known as chronic tophaceous gout. (2) Treating the acute flare ups early by reducing joint inflammation and correcting high blood uric acid levels is the goal, but when gout becomes chronic, reducing tophi becomes part of the equation for effectively managing the disease, as tophi formation can lead to progressive joint damage. After the acute attack has been relieved, the focus goes to treating the hyperuricemia (high levels of uric acid in the blood). This is a lifelong process aimed at maintaining normal blood uric acid levels. (2)
Reducing tophi really comes down to controlling the disease in its chronic state. This can be achieved in several ways. Medication is used to dissolve tophaceous deposits, and thereby reducing the amount of joint damage that these tophi cause as they build up. The medication will be aimed at either increasing uric acid excretion from the body with a uricosuric drug, or blocking uric acid production with allopurinol. In severe cases both drugs may be used together. (1) Your doctor will likely evaluate the concentration of urate in the body periodically to help guide any dosage adjustments that are needed to maintain an optimal level of uric acid in the blood. Even with medication, in may take months to several years for the tophi to resolve. Large tophi in areas with healthy skin can be removed surgically. (1)
There are other important lifestyle changes that can and should be made to reduce flare ups. These include maintaining ideal body weight and making sure alcohol is consumed only in moderation if at all, due to the fact that it leads to a marked rise in uric acid. (1) Diet also plays an important role. Avoiding purine-rich foods such as liver, kidney, sardines, anchovies, and sweet breads is important in patients with tophi because dietary purine intake causes elevation of uric acid in the blood. Fluid intake of over 3 L/day is also recommended for all gout patients. (2)
As with any chronic disease, the more you know, the better your chances of managing the disease effectively are. Treating acute flare ups early is important, and having a long term plan with your doctor to manage this chronic condition is imperative for reducing or preventing tophi and the subsequent pain and joint damage that accompany them.
Bert offers a book on what to do to get out of gout pain fast and what to do to start dissolving the tophi in your joints at his website, The Gout Killer.
Life is about learning and growing. To get over your gout health issues, it’s time to take a step in a new direction. Check out Bert’s gout book to start out. It could be the best thing you ever did for yourself.
The Merck Manual. 7thEd. Merck Research Laboratories. Whitehouse Station, N.J. 1999.
Porth, Carol. Pathophysiology Concepts of Altered Health States. 7th Ed. Lippincott Williams & Wilkins. 2005.