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Tophi and gout-related joint damage

Prepared 2026-10-29 · Read as Markdown

Tophi are organized deposits of urate crystals with a surrounding tissue response. They can form beneath the skin, around joints, or in other tissues. Some start out painless, but can interfere with movement, damage tissue, or change joint shape. A lump needs assessment; its appearance alone does not establish what it is. [S06]

Schematic elbow detail and tissue cross-section label skin, a localized urate crystal deposit, and the surrounding tissue response; marked as non-diagnostic.
What a tophus represents · illustration

Why tophi change the treatment conversation

ACR strongly recommends urate-lowering treatment for subcutaneous tophi or imaging damage caused by gout. NICE considers a lower urate target below 300 µmol/L (5 mg/dL) with tophi or chronic gouty arthritis. Deposits take time and sustained control to shrink. A target blood result does not mean a large deposit will disappear immediately. S02 S03

Report changes in skin and function

Tell your clinician about changes in size, pain, movement, or footwear tolerance. Broken or draining skin, a newly hot or red area, fever, or worsening symptoms needs assessment for complications including infection. Do not cut, drain, or attempt to dissolve a lump at home. S03 S05

Persistent disease deserves a wider review

Review diagnostic confidence, the target, dose adjustment, access, and medicine use. Pegloticase may be considered for selected refractory chronic gout under specialist care, with important infusion, allergic-reaction, and G6PD precautions. Some complications may also need surgical or wound assessment. S03 S13

How to interpret images

Photographs show specific cases, not a diagnostic matching exercise or a forecast of what will happen to you. Tissue microscopy is a different kind of view again. Neither should be used to judge severity or treatment prospects without clinical context.

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