How Are Gout Crystals Removed?

Man with painful and inflamed gout

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If you’ve been diagnosed with gout, you may wonder, can gout be removed? Gout can be an extremely painful condition. A common 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.

What Are Gout Tophi?

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.

How Do Tophi Develop?

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 doctor’s examination and a biopsy of the fluid in the nodule can help determine whether or not the mass is a gouty tophus.

How Are Tophi Treated?

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 doctor 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 doctor 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 doctor may suggest surgery.

When Is Surgery Considered?

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.

What Are the Surgical Options?

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

  • Shaver technique: Intra-lesion shaving is done by making multiple small incisions of the skin to allow direct access to the tophic mass. Suction and irrigation are performed simultaneously to remove the chalky deposits of sodium urate at the same time.
  • Full surgical removal: The tophi may be fully excised and removed from the joint as much as possible without destroying the surrounding tissue. Removal of gouty deposits and nodules occur at this time as well. 
  • Joint fusion: If the joint is unstable and damaged by the tophi it may be recommended to have joint fusion. Smaller joints will be fused together to limit movement and reduce pain.
  • Joint replacement: If the gout tophi cause irreversible damage to the joint, you may need a total joint replacement such as in the knee or hip to restore function and reduce pain.

A Word From Verywell

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 doctor. Following your doctor’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.

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Additional Reading
  • Gout | Arthritis | CDC. Cdc.gov. https://www.cdc.gov/arthritis/basics/gout.html. Published 2021.

  • Topics H. Gout | Gouty Arthritis | MedlinePlus. Medlineplus.gov. https://medlineplus.gov/gout.html. Published 2021.