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Gout - Management
How should I manage people with gouty tophi?
- The principles of management of people with tophi (and other complications of gout) are similar to those for managing people with frequent recurrences of gout.
- The natural history of tophi may vary from individual to individual. Tophi can remain static, enlarge, or dissolve with urate-lowering therapy. As tophi dissolve they may ulcerate through the skin. This can be misinterpreted as evidence of local infection. Reassure the person that the ulcer should heal as the tophaceous material completely resolves or discharges [Gibson, 2005].
- Rarely, tophi may be so large or painful that referral is indicated. Occasionally surgical excision may be considered.
- A case report describes successful surgical removal of a large painful tophaceous nodule on the plantar aspect of the first metatarsophalangeal joint. Surgery relieved the pain and restored the ability to wear shoes and walk without discomfort [Naas and Sanders, 1998].
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