Tophi, also known as gout nodules, is a crystalline substance that precipitates and deposits urate and accumulates to the joint or cartilage. Tophi stones, varying in size, the smallest like sesame seeds, especially large, will be the size of an egg. Tophi, commonly found in the pinna, feet, and fingers, can also occur in the internal organs. How are tophis formed? Can it be prevented? What should I do after tophi occur? Does it need to be surgically removed? Let's answer your questions now.
As we all know, after the level of uric acid rises, hyperuricemia occurs. Uric acid, which cannot be dissolved in the blood, will precipitate crystals if the concentration of uric acid in the blood is too high and exceeds saturation. Ordinary people can do a small experiment at home, to a cup of brine, continue to add salt, will soon find that the bottom of the cup appears white sediment, the result of this experiment, is the human body appears tout stone reason. Urate flows throughout the body with blood, and the brain has a blood-brain barrier through which larger molecules cannot pass. As a result, crystals precipitated from urate may be deposited in any part of the central nervous system.
Tophi, on the surface of the body, is easy to appear on the extensor side of the joint, tendons, and bone process surfaces, and the most common site is the outside of the ear, followed by the 1st metatarsophalangeal joint on the foot, ankle, finger, wrist, knee joint, Achilles tendon, etc., which is also a common part. The specific manifestation is to highlight the yellow-white nodules on the surface of the skin, the texture is harder, the surface is thinner, if broken, it will flow out of the white paste, and it will not heal for a long time. However, because uric acid inhibits bacterial growth, infections occur less often. However, it can lead to chronic inflammatory granulomas, forming fistulas that are difficult to heal. Tophi, if deposited on the joint site, can induce gouty arthritis, causing damage to the joint cartilage and bone, as well as fibrosis of surrounding tissues, resulting in joint swelling, pain, stiffness, and deformity.
Tophi can appear in the internal organs, and the common sites of aggression are the renal parenchyma, ureter, bladder, aorta, heart valves, myocardium, and may also appear in the liver, gallbladder, biliary pancreas, etc. Tophi, which mainly invades the urinary system in the internal organs, can cause stones, leading to complications such as renal colic. From the mechanism of the production of tophi, you may have understood that in fact, many kidney stones, for example, are a special type of tophi. Uric acid stones, also known as soft stones, can be passed by X-rays, so they cannot be found on film examinations and can only be detected by pyelography. If uric acid stones contain calcium salts, they are indurable stones that can be developed in plain X-rays. Studies have found that about 40% of urinary tract stones appear before gouty arthritis, so people with a related medical history should pay more attention to changes in uric acid levels and strengthen gout prevention.
The formation of tophi is closely related to the level of blood uric acid, and the higher the uric acid level, the greater the risk of tophi. Studies have shown that if the blood uric acid level reaches more than 530umol/L, 50% of tophi will develop, and about 20% of patients with tophi will also develop urinary stones. After the first onset of gout, tophi forms within an average of 11.6 years. Within 5 years after the first onset of gout, the proportion of tophi formation is about 10%, within 5 to 20 years, the proportion is 55%, and after more than 20 years, the proportion is about 70%. Therefore, most people who have had gout but have not been thoroughly treated and who change their life behavior will eventually develop tophi. The presence of tophi visible to the naked eye is a sign of the progression of gout to chronicity, and it also means that kidney function impairment may be difficult to avoid.
After the formation of tophi, 4 countermeasures need to be taken and active treatment is required. The first item is to change the lifestyle, for example, drink a lot of water to achieve the purpose of diluting and promoting the excretion of uric acid, the amount of water replenished per day should exceed 2000 ml, it is recommended to drink boiled water or light tea water to hydrate, at the same time, it is necessary to limit the intake of purine foods, avoid the intake of juices and alcoholic beverages. The second measure is to alkalinize the urine, control the pH of the urine at 6.2 to 6.8, and use sodium bicarbonate while taking uric acid-lowering drugs under the guidance of a doctor. Item 3 is uric acid-lowering drug therapy. Controlling the level of blood uric acid below 300 μmol/L contributes to the dissolution of tophi.
The fourth measure to deal with tophi is surgery. There are six main types of cases that require surgical removal of tophi, the first of which is that the tophi is large and ruptured, which may cause infection. Second, after drug treatment, tophi does not disappear and affects finger movement or walking. Third, there are tophi in the tendon, the pain is pronounced, and it causes dysfunction. 4. Tophi causes nerve compression, with obvious symptoms. Fifth, tophi causes bone destruction, which leads to fractures. 6th, joint stiffness or deformity appears. At present, there are different opinions on the surgical treatment of tophi, and some scholars suggest that tophi with a diameter of more than 1 cm needs to be actively treated surgically. However, other scholars have a different view, arguing that the key measure is to reduce blood uric acid levels, otherwise, after surgical removal, tophi will still form.
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