title: The gouty tophus: a review.
abstract: The tophus is the cardinal feature of advanced gout. This review summarises recent research into the biology, impact and treatment of tophaceous gout. Microscopically, tophi are chronic foreign body granuloma-like structures containing collections of monosodium urate (MSU) crystals surrounded by inflammatory cells and connective tissue. Extracellular trap formation mediated by neutrophil interactions with MSU crystals may be a central checkpoint in tophus formation. Gouty tophi impact on many aspects of health-related quality of life. Tophi are also implicated in the development of structural joint damage and increased mortality risk in people with gout. Effective treatment of tophaceous gout requires long-term urate-lowering therapy, ideally to achieve a serum urate concentration of <5 mg/dL (300 μmol/L). Recent advances in gout therapeutics have expanded urate-lowering therapy options for patients with severe tophaceous disease to allow faster regression of tophi, improved health-related quality of life and, potentially, improved structural outcomes.
authors.affiliation: Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd. Grafton, Auckland, New Zealand, a.chhana@auckland.ac.nz.
authors.forename: Ashika
authors.initials: A
authors.lastname: Chhana
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
mesh_terms: D018450:Disease Progression; D006073:Gout / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D011788:Quality of Life; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid