By Dr Irwin Lim, Rheumatologist
When I see patients walk in with this, I'm no longer shocked.
It occurs too commonly so the "wow" factor's been lost.
Now, I feel sad. And that's tinged with a continued disbelief that someone could allow these things to grow and to not try to treat the underlying cause.
These are Tophi.
Lumps of urate crystals deposited into soft tissues. They occur gradually, usually taking years to accumulate.
And they occur in patients who get repeated warnings. In the form of gout attacks (read about gout here).
These warnings aren't subtle. There's often acute pain and swelling. It's meant to be quite severe with the patients usually finding it hard to walk and typically, they're not shy in reaching for an anti-inflammatory.
If you had some skin lump somewhere on your visible body growing and growing, I would assume you'd want to know what it is, and as importantly, you'd want it removed. Fixed.
So, I still don't understand the psyche of patients with tophaceous gout.
Even if you were to blame poor advice from the 1st doctor they consulted, you'd expect some more self-directed investigation to take place or you'd press for another opinion.
The reason I feel sad when I see this?
Well, it's completely preventable. Effective gout medication, when used properly, in a compliant patient stops this occurring (read gout: the most curable joint disease....)
Even after the lumps have formed, it's not too late. We can shrink them over time. We can reduce more damage from happening.
While I assume it's unlikely anyone with gout is reading this piece, if you are, maybe you can help answer my question.
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.This blog focuses on arthritis, healthcare in general, and Connected Care.
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