For some people, gout can be chronic, which means multiple, severe gout attacks several times a year. Some people who have repeated gout flares or overly high levels of uric acid for several years develop a form of gout called tophaceous gout. Chronic gout, sometimes called gouty arthritis, can lead to a number of serious complications if left untreated. (2) Complications of gout and hyperuricemia can include:

Joint damageJoint deformityLoss of mobility or range of motionBone lossTophi deposits throughout the bodyKidney stonesChronic kidney disease

What Is Tophaceous Gout? What Are Tophi Deposits?

People with tophaceous gout can get tophi, which are hard uric acid deposits that form beneath the skin. Tophi look like chalky lumps under the skin. They can be found on or near the elbow, finger, or toe joints. Tophi can also appear on the outer part of the ear. Tophi can destroy bone and cartilage, leading to joint damage and deformity. (3) They can swell during a gout attack and pop through the skin and become infected. With treatment, tophi can dissolve and eventually disappear. Not everyone with gout develops tophi. Certain groups share a higher risk for tophaceous gout, including: (4)

Organ transplant recipients who receive certain types of medication to prevent transplant rejectionPeople who can’t take uric-acid-lowering medicines (because of kidney failure or drug allergy)Postmenopausal women, especially those taking a diuretic. (Diuretics, used to treat high blood pressure, can raise uric acid levels.)

Treatment for Tophaceous Gout and Tophi

Treatment for tophaceous gout typically involves long-term therapy with one or more uric-acid-lowering medications. (5) Achieving and maintaining a uric acid level of 6 milligrams per deciliter (mg/dl) or below can help reduce the risk of future gout flares. (6) These medications will also cause tophi to dissolve and disappear. Uric-acid-lowering medications take time to work. It may take several months of treatment before uric acid levels start to go down. Some uric-acid-lowering medications for gout include:

probenecid (Benemid)losartan (Cozaar)allopurinol (Zyloprim)febuxostat (Uloric)pegloticase (Krystexxa)

Drinking plenty of water, exercising, maintaining a healthy weight, and avoiding foods and beverages that trigger gout attacks (alcoholic and sugar-sweetened drinks, red meats, organ meats, certain kinds of seafood) can also help lower uric acid levels.

Treating Gout and Tophi With Surgery

Uric-acid-lowering drugs can reduce the size of tophi over time. Some people may opt to have tophi surgically removed for cosmetic reasons. (7) Your doctor may recommend surgical removal for tophi if they are causing mechanical problems with your joints. Surgery for gout can help to reduce joint problems caused by tophi, including difficulty walking or nerve damage from tophi pressing against a nerve. Tophi can erode through the skin, causing chronic ulcers that can become infected. These may require surgical removal. Tophi removal is a relatively simple procedure. Your doctor will make a small incision on the skin over the tophi, remove the mass, and then suture the wound. People with severe joint damage or bone loss around the joint may need additional joint replacement surgery.

Excess uric acid can build up in the blood and form crystals. This may happen if the body is making too much uric acid or if the kidneys are having a hard time filtering it out. These spiky, urate crystals may also cause a stone to form in the kidney or other parts of the urinary tract. Kidney stones can get stuck in the urinary tract and cause severe pain in the side of the abdomen or back. They pass out of the body in urine. Kidney stones caused by uric acid crystals occur in about 15 percent of people living with gout. (4) Uric acid gets excreted by the kidneys. Some medications aim at lowering uric acid levels by increasing the amount of uric acid excreted by the kidneys. These medications may increase the risk of kidney stones in some people. (4) Talk with your doctor if you are using a uric-acid-lowering drug and are developing kidney stones. Your doctor may opt to put you on a different medication.

There’s a relationship between gout and chronic kidney disease. Chronic kidney disease is a condition in which you slowly lose kidney function over time. The kidneys are important because they help remove waste products (such as uric acid) and urine from the body. (8) People with chronic kidney disease are at an increased risk for gout, and people with gout are at an increased risk for chronic kidney disease. (9) If the kidneys aren’t working properly, uric acid can build up in the body. That’s why kidney disease sometimes leads to high uric acid in the blood. High uric acid can cause gout. One way that gout may contribute to chronic kidney disease is through kidney stones. People with recurrent kidney stones are at an increased risk for chronic kidney disease. The National Kidney Foundation recommends that people with gout get checked for chronic kidney disease. (9) Your doctor may take blood and urine samples to test for it. Doctors can use different methods to determine if kidney damage is present. For example, a GFR test assesses your glomerular filtration rate, measuring how well your kidneys filter fluid each minute. And an ACR test measures your albumin-creatinine ratio — substances in the urine that help determine if kidney damage is present. (9)