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In my readings on this topic, I have always had the impression that a tophus forms over a long period of time: It starts out small but firm, and then grows gradually over time. Is that correct?
My most recent experience is that my toe was afflicted by swelling and pain, and then a small white area started to form on the right-hand side of the “knuckle”. It swelled up soft and white; and then over the next 5 days is spread out, expanding in depth while almost encircling the upper surface of the toe. Ultimately, it took over about half of the top surface of the toe, which looked as if covered in a soft warm ballon of vanilla icecream. At that point the doctors suctioned it out with a hypodermic needle, leaving the skin wrapped around the toe like a popped balloon.
The color and onset would make one think this was an infection with pus, but the substance taken out was not pus; they have sent it to the lab to find out what it really is.
Is this typical of how a tophus forms, or is it more usual for it to be a gradual process, according to the impression I've received from my readings?
Tophi are a bit like volcanoes: some rumble & grumble away for years slowly adding deposits to the surrounding landscape; others are violent eruptions that devastate the local area in one go. What the Dr syringed out will undoubtedly be confirmed as monosodium urate – good riddance! and this act may have minimised further joint damage.
But you don't mention blood tests, diagnosis of gout,?urate lowering therapy etc. and?without these steps in hand you're not much better off than before the cataclysm.
I have had occasional attacks of gout over the last 10 years, and have just now been prescribed allopurinol. But I have never before had my toe “wrapped” in white like that.
Also, what is odd is that there is a long-standing lump on that knuckle, that appears to be a tophus: white shows through when you apply a little pressure. But there is no damage to the bones, as confirmed by X-rays: the lump deflects the toe but not by intruding into it. Two doctors separately remarked on that.
nealjking said:
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Is this typical of how a tophus forms, or is it more usual for it to be a gradual process, according to the impression I've received from my readings?
Neil, Odo gave you already the best answer which could be given by any knowledgeable goutie. However, as he said: “you don't mention blood tests (SUA), diagnosis of gout, urate lowering therapy etc. and without these steps in hand you're not much better off than before the cataclysm”, nor age, weight, physical activities, family history, all factors influencing the creation and/or control of gout.
You may be a “god-sent” (coming from an atheist, but I don't have any qualms using expressions of non-atheists) goutie to this forum/community. Since you live in Germany and Siemens invented and of course sells the equipment, called Somatron, you might be the first goutie here to get a Somtron-DECT image. Put DECT in the upper, right-hand search field and you'll get all the info necessary to understand DECT. (There are only 2 or3 of these dual energy machines here in America, but I know they are already quite common in the UK, and they must even be more common in Germany. It's expensive here; I don't know how expensive a DECT image in Germany is and how much insurance covers that procedure.)
By the way, for your info: DECT is right now the only non-evasive procedure to assure gout=MSU/UA crystals or deposits from other non-goutie deposits and possible bone defects. While bone defects are seen by x-rays, x-ray does NOT “see” definite urate deposits.
nealjking said:
I have had occasional attacks of gout over the last 10 years, and have just now been prescribed allopurinol. But I have never before had my toe “wrapped” in white like that.
Also, what is odd is that there is a long-standing lump on that knuckle, that appears to be a tophus: white shows through when you apply a little pressure. But there is no damage to the bones, as confirmed by X-rays: the lump deflects the toe but not by intruding into it. Two doctors separately remarked on that.
Good, you're taking Allo. Make sure it's enough to get your SUA down to ~ 5.00mg/dL (check the info on the side bar to convert to the other values used by test labs: ?mol, mmol). 300mg per day works for most people. Drs like to start off with 100mg as a precaution against allergic reaction, but this is not necessary for more than a couple of weeks/ 1 month at most (if indeed at all). The important thing is regular blood testing to determine correct dosage. A few people have their own meters which, once you've mastered the technique of getting consistent results, give a good enough/rough guide to your SUA to keep tabs on your progress at the beginning of urate lowering therapy. I hardly ever use mine these days, but I'm glad I have it available.
Your lump tophus is the chronic type which the body walls off by laying down proteins, effectively sealing it. There is a theory that these deposits will never go away, because they are out of reach of the systemic blood supply which carries away toxins & dead cell debris.
The other was the acute version.
I have had the tophi pop up overnight on my hands, just amazing, not there Tuesday and?voila, there Wednesday. ?They? seem to be outside the joint and almost painless.
The largest?one on my thumb sat for a year before moving OUT…ever so slowly down and under the nail, raising the nail by about a quarter inch. I popped it with a red hot paper clip through the nai (yep, they melt) and out oozed the toothpastey stuff for a week…CURED!
?
I would imagine that with time, layer after layer would accrete onto the original giving it that? 'bunch of grapes” appearance of chronic untreated gout. May we never find out.
nealjking said:
zip2play,
Why didn't you get it punctured before it migrated below the nail?
Because of the old uncertainty: Is it arthritis or is it a gout tophus?
When it started moving downwards, I became convinced it was the latter. Microscopc examination confirmed it was a mass of urate?a gazillion dendritic crystals.zip2play,
Your consideration, “Is it arthritis or is it a gout tophus?”, confuses me: I thought gout was considered a form of arthritis. So, if it was arthritis but NOT a gout tophus, what else would that white lump/stuff be?
By the way, I have a whole sequence of photos of the development of my tophus over 5 days. I've never seen anything like it posted anywhere, so maybe Keith Taylor, the webmaster of GoutPal, would like to look at it. However, I have been unable to figure out how to actually contact him, as all leads seem to go in circles, never actually showing an email address or (as far as I can recognize) a message system. Anybody who knows how is welcome to forward this message to him.
Well, I already said I couldn't figure out how to contact him through the GoutPal system of pointers. Does that count as sufficiently negative?
nealjking said:
zip2play,
Your consideration, “Is it arthritis or is it a gout tophus?”, confuses me: I thought gout was considered a form of arthritis. So, if it was arthritis but NOT a gout tophus, what else would that white lump/stuff be?
I guess I should have more precisely ?said “IS it an?OSTEOarthritis node ot a gout tophus?”
Or the pain might be from “RHEUMATOID arthritis or gout,” another differential doctors have trouble making.
?
So basically, “gout or the OTHER arthritises.”
?
In fact, I am not 100%?certain whether my finger nodules are the toplhi of gout or the Heberden's nodes of OE…or a combination of the two.
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