What should I do if tophi appears? Why surgical removal is not recommended

As a gout patient, you should have heard of the name "tophi" more or less, and those terrifying pictures on the Internet are not what ordinary people dare to see, not to mention that there may be such a situation around you
.

Tophi is a late manifestation of gout, and many patients are confused about whether surgery is needed, in order to make everyone more aware of the relevant knowledge
of tophi.

How is tophi formed?

Tophi, also known as gouty nodules, is due to the increase of blood uric acid due to purine metabolism disorders, urate formation crystals deposited in soft tissues formed by nodular swelling, which can be distributed throughout the body
.
It got its name because of its
hard texture and similar shape to round stones.

The formation of tophi and the level of blood uric acid showed a positive correlation, the higher the blood uric acid level, the longer the duration, the greater the chance of forming tophi
.

Clinical studies have shown that when the blood uric acid is above 535.
32umol/L, 50% of gout patients can produce tophi; In the absence of standard treatment, 70% of patients with gout develop tophi within 20 years of the first attack of gout
.

The hazards of tophi

Tophi is equivalent to a huge urate warehouse in the human body, which can continuously release urate into the blood, increase the burden on the patient's kidneys, and seriously lead to renal insufficiency
of patients.

The data show that the incidence of uric acid kidney stone disease in the gout population is 15%~22%, while the incidence of kidney stones in the general population is about 2%~5%.

In addition, if tophi is not cured for a long time, it can cause connective tissue hyperplasia and soft tissue destruction, resulting in limited joint mobility, deformity, skin ulcers and infections, etc.
, and even amputation is required in severe cases, bringing great harm
to the physical and mental health of patients.

Does tophi need to be surgically removed?

For patients with more severe symptoms, surgical resection can be considered, in addition to improving the patient's limb function and appearance, it can also reduce the storage of tophi reservoir, thereby reducing the total amount of uric acid in the body, so as not to further aggravate the damage
to important organs of the body with high uric acid.

Surgery may be considered in the following situations:

(1) Tophi is large and broken and open, in order to prevent secondary infection;
(2) There is no improvement after conservative treatment, and it affects the function of bones and joints, causing inconvenience to life; (3) There are obvious pain symptoms in the tendon; (4) Tophi lesions destroy bone and cause local fractures; (5) Tophi causes nerve compression, and the symptoms are obvious
.

Shortcoming:

The treatment method of surgical resection can only remove tophi in parts of the body, and there are many postoperative complications, often including poor skin healing and necrosis at the excision site, and some patients have worse postoperative results than before surgery
.

In addition, gout is essentially a metabolic disease, surgical treatment can not fundamentally cure gout, if the patient has not taken strong uric acid lowering treatment measures after surgery, then as long as uric acid continues to rise, new tophi
will be produced again.

For patients with gout, the key to the treatment of tophi is long-term oral drug uric acid lowering therapy, so that the serum uric acid level can reach the standard
for a long time.

The 2020 American College of Rheumatology guidelines pointed out that by taking uric acid-lowering drugs to control blood uric acid below 300umol/L and maintain this range, it is safer to accelerate the dissolution
of tophi.

Traditional Chinese Medicine Law

Traditional Chinese medicine believes that gout belongs to the category of "paralysis", and the formation of tophi is because gout patients do not heal for a long time, the flow of qi and blood is not smooth, resulting in wet cohesion, attached to bone joints, and the formation of sputum nuclei is a clinical manifestation and outcome
in the course of the disease.

Therefore, the treatment of tophi can be treated by eliminating phlegm and softness, activating blood circulation and removing stasis, breaking knots and opening stasis, channeling and relieving pain, etc.
, and acupuncture therapy, tuina therapy, external application of traditional Chinese medicine, etc
.
are more commonly used.

1.
Acupuncture therapy

The acupuncture method can unblock the meridians, harmonize yin and yang, and help correct and dispel evil; Moxibustion can warm the cold and eliminate the knots, which is conducive to the treatment
of tophi.

2.
Tuina therapy

TCM Tuina has the effect of unclogging meridians, promoting qi and blood circulation, smoothing joints, and helping to accelerate the crystallization and dissolution
of urate.

3.
External application of traditional Chinese medicine

External application of Chinese medicine can directly act on the affected area for easy absorption, so as to achieve the effect of clearing heat and reducing swelling, collecting sores and building muscle, and helping to help the healing
of broken wounds.