Gout is a metabolic disorder and it is characterized by an increased level of uric acid in the body. Tophi gout is a term that refers to a condition in which persistently increased level of uric acid leads to a deposition of uric acid or monosodium urate crystals in joints, bones, cartilage and tendons. Tophi are quite painful and may restrict movement. They predominantly affect the big toe, ankles, fingers, wrist, elbows and heels. If they progressively grow tophi may cause serious damage to the affected tissue.
Treatment for tophi gout has significantly improved since the time the condition was first recognized. Before special agencies such as FDA or EMEA allow drugs to be used in treatment of certain illnesses these medications must undergo specific studies and trials. So, soon enough there is possibility for tophi gout sufferers to try new drugs.
Tophi Gout Treatment
The goal of the treatment is to reduce the size of tophi, hence decrease the intensity of symptoms and to prevent their further growth. Febuxostat and pegloticase are two relatively new drugs which have been investigated for treatment of tophi gout. These medications are in many cases able to dissolve tophi. This effect is highly desirable particularly in patients suffering from extreme cases of tophi. In phase 3 trial extensions both medications have been successful against tophi. Initially, administration of flebuxostat had little effect (trial of 6 months and 1 year) but after a two year trial extension this drug managed to provide patients with a complete tophi removal success rate of over 50%. Unfortunately, data regarding pegloticase is not fully available and approved yet but still even this drug has been successful in trial extensions.
Tophi generally first develop in toes, hands, ankles, elbows, knees, other body tissues and locations. In some cases tophi may rupture the skin and ulcerate and if left untreated these ulcerations can get infected and lead to even more serious condition called septicemia. Progressive and untreated tophi almost always lead to damage to the affected tissue. The growth of these collections can be halted and tophi may start to dissolve if the level of uric acid in the blood is reduced to 6mg/dL or below.
Tophi can be surgically removed. The goal of the surgery is to breakdown the deposits and remove them from the body. However, it may not be possible to remove all tophi from the body. And there is also a possibility that patients are first administered medications and then to undergo surgery. In case the patient responds well to dietary changes and medications such treatment will continue until tophi completely disappear from the body.