From a gout perspective, what are tophi?

Defining tophi in the context of gout

Tophi is a step up for the worse in the world of gout as it is a rife accumulation of uric acid crystals, enough to break through the skin and cause malformation.

Those not in the know may ask the question “what is tophi?” which is grammatically incorrect. Tophi is in plural form—that of the word tophus, derived from the Latin word tophos, which is a porous volcanic stone. In the context of gout, a tophus may also be referred to as tophaceous gout.

Anyone who has reached the point of tophi formation has had a longstanding, uncontrolled bout with high levels of uric acid for years. They are known on average to develop ten years after the onset of gout. However, recorded cases prove they can develop anywhere from three years, earliest, to forty-two years, latest.

As opposed to gout, tophi do not only form around joints. They have been seen on cartilages and bones, and in rare cases even in the kidneys and the nasal cartilage. Another rather interesting contrast with gout is that tophi is more common among women. Also, depending on where they form, tophi can be anywhere from harmless to critical, sometimes deeming a joint or an organ unusable.

Treating tophi follows the same principles as with gout. By lowering uric acid levels, a tophus will eventually dissolve itself. But, we’ll reserve that for another post. For now we hope we’ve defined tophi in rather easy-to-digest manner for the gout-concerned citizen.

Main Symptoms of Gout in the Fingers

Gout may be a common ailment, but gout in the fingers is rather rare. Even if you have had gout (elsewhere) in the past, the symptoms—when it happens in the fingers—may come as a surprise to you. For one, non-gouty arthritis normally happens in the hands so there can be some misdiagnosis at the start.

Personally, I have not had gout in the fingers—thank goodness, as I have heard horrible things about it. It can cause malformation from the accumulation of tophi. But don’t fret, as long as you catch it early and start with treatment and detoxification, the worst can be prevented.

To say for sure if it is in fact gout in the fingers, you should at least familiarize yourself with the symptoms. If you are a gout veteran, at least you are already familiar with the pain (and the burning sensation) which can be advantageous compared to first-timers. Below is a shortlist for reference should the dreaded day arrive. So, without further ado, below are some finger gout symptoms.

Minus the knuckles, there are two joints in every finger except the thumb. Uric acid crystals can accumulate in any of these joints, which means gout can attack any finger. It can also happen to more than one finger at a time; it most commonly happens to the index finger and thumb.

Older people are more susceptible to gout in the fingers. It takes years for gout crystals to accumulate in the finger joints to the point that they cause intense swelling. Finger gout is also common to post-menopausal women.

When it happens, you can just suddenly wake up with a red, swollen and painful finger. However, with gout, the swelling and the pain usually increases in a matter of days (even hours). It will come to the point where you will not be able to move the whole finger (not just the joint) and even render the affected hand useless.

If it happens in the finger pad (outermost joint), the cuticles can become malformed and even break.

The swelling is, of course, reddish, but it also appears somewhat shiny due to the skin being stretched. The affected area might also feel hot—the burning sensation the ailment is notorious for.

The affected area should also become extremely sensitive even to the slightest touch. Discomfort can arise even from the touch of soft things such as clothing (cloth).

Because gout and non-gouty arthritis comes and goes, even your doctor might not be able to tell if it is in fact gout just by looking at it. It is important to have your uric acid levels checked as soon as possible so treatment, including relief from pain, and detoxification can be started as soon as possible.

Gout in Images: Uric Acid Crystals

Gout is defined by the existence of one and only one thing: uric acid crystals. Known otherwise as urate crystals or gout crystals, once these form—on joints; from excess uric acid, of course—all hell breaks loose. But, what exactly do these crystals look like?

This post is a compilation of gout crystal images—actual photos, renderings, x-rays and shots taken from microscopes. A word of caution though, some images are not for the faint at heart. So, let’s begin.

uric acid crystals 1

The photo above is a simple rendering showing where these urate crystals form exactly for gout-on-toe cases.

uric acid crystals 2

Above are actual x-rays of several gout cases on different joints.

uric acid crystals x-ray on left toe

A clearer x-ray view of the left foot. The crystals show easily with their white contrast.

microscope photo of gout crystals

Above is a photo taken from a microscope. The one on the left is polarized. You can see the crystals as having a needle-like appearance.

gout crystals sucked via injection

The above photo shows the crystals taken from an inflamed joint. These were accumulated by a syringe.

urate crystals 1

Another photo showing uric acid crystals that have somewhat solidified on the joint.

gout crystals 1

The above photo is what we've warned about above. Extreme cases of gout need surgery to remove the uric acid crystals.

gout crystals 2

Another gorry photo taken from surgery.

Photos taken from various sources.

Gout and Water: Does Drinking Water Help Gout?

During my early days with gout, someone actually told me that all it took was to drink lots of water. He was not a doctor or anything, but he has had multiple attacks of gout nonetheless; me, on the other hand, was only one episode in back then.

In this blog, I usually share my own experiences when it comes to gout—be it medications, alternative treatments, what to expect, etc. Unfortunately, I might not be able to on this one. It’s not that I do not believe drinking water helps gout, it’s just that I haven’t really observed any change worth attributing to just drinking water. Of course when an attack happens, I take medications and change things up a bit, so it would be really hard to pinpoint what water actually does. Besides, I have been drinking water since all kinds of ailments—that I was too young for—started showing up.

From hereon, I speak from what I have learned so far. It might not be from firsthand experience, but if you have gout, you can’t help but read up on a lot of stuff, and consult with as much people (doctors or otherwise) as you can.

To say the least, water is good for a lot of things; it is probably the only think you can’t have too much of.

Water is the most natural diuretic available to man. Kidneys play a vital role in controlling gout. With that said, when it comes to gout, water helps the body flush out excess uric acid. By being adequately hydrated at all times, uric acid concentration will be at a minimum. Think of water as a powdered drink mix. The more water you add, the less tasty your drink gets. Also, it is a known fact that dehydration is a known trigger for gout. Taking from the opposite of what was previously discussed, the more dehydrated your body gets, the more concentrated uric acid becomes. This also makes it easier for uric acid crystals to form, hence, gout.

To start your own gout water therapy, drink anywhere between 12 to 15 glasses of water (around 3 liters) everyday. Taking it at several smaller doses is better than drinking liters at a time. Water content of foods and other non-alcoholic drinks can be added to your intake levels, especially if you find it hard to drink as much. Also, compensate accordingly for hotter days or when exercising.

How to Dissolve and Remove Uric Acid Crystals

During a gout attack, the normal course of treatment follows this basic premise: reduce pain (caused by swelling) by reducing the swelling, and eliminate the cause of swelling itself—uric acid crystals.

Swelling is normally reduced by taking non-steroidal anti-inflammatory drugs such celecoxib and indometacin; dipping the affected area in icy water or using cold compress can also be done in conjunction with medications for faster relief.

As for removing and dissolving gout crystals, well, unfortunately, there is no medication that does this in a laser-targeted manner. For one, your body’s immune system will eventually break down and eliminate uric acid crystals in time. Long-term gout medications are generally categorized as uricosurics, which are agents that lower uric acid levels in the body by increasing the elimination of uric acid by the kidney. But, even uricosurics are not prescribed during an attack—unless the patient is already undergoing a treatment cycle.

So why write this article then? Well, there are a couple of alternative methods people believe dissolve gout crystals in one way or another. At the top of the list is contrast hydrotherapy. Contrast hydrotherapy is simply alternating between hot and cold (compress or dip) on the affected area. Subject the affected area for 30 minutes in heat, then switch to cold for 15 to 30 seconds. Repeat this cycle for a number of times; revisit the hot or cold compress article to learn more about it.

Another popular method is by literally drowning yourself with water by increasing your daily water intake. What this does is basically what modern diuretics do. Technically, uricosurics are still considered diuretics because they eliminated toxins through excretion.

Whether these methods “dissolve” gout crystals is left to the discretion of each patient. What these are, really, are non-harmful alternatives (with no side effects) that can be taken safely by anybody who wishes to.

Gout is an ailment that requires permanent, moderate to heavy changes to one’s lifestyle combined with proper medications. It is very likely to become a chronic disease which is why doctors give more importance on the long-term—controlling uric acid—after the pain has been eliminated.

Gout Among the Young: Can Children Get Gout?

The question is valid. Gout is a hell of an experience to endure so as parents we need to keep our kids as far away from it as possible. The good news though, is that gout is very, very rare among the young ones.

Let’s expand the context of the world children in this article a bit to encompass everyone below 18 years. I was 28 years old when I first had gout and I was still considered too young to be a victim. In fact, I’d be willing to bet you’ll have a hard time finding someone—you personally know or are acquainted to—below 30 who has had gout, let alone below 25. In my circle, the youngest I know of was 24 when he had gout.

However rare, my cause was a combination of 60% lifestyle and 40% hereditary. I was really very “stale” during my mid-twenties as I was working from home, eating without caution, and barely exercising. Add to that a history of naturally-high uric acid levels in the family and boom, gout when I least expected it.

Now, you wouldn’t expect your kids to be living off a diet of beer and red meat in their early years, wouldn’t you? No matter how bad your family’s genes are, it is still rare for a child to get gout without any underlying genetic cause. A kidney problem can be the culprit, as the liver is responsible for excreting excess uric acid. Gout has in fact been recorded in as early as infancy due to renal failure (kidneys fail to filter toxins from the blood).

If you have a healthy child, you need not worry. It is even more rare if you have a daughter—only one in five of affected adults are women. But if you observe symptoms such as limping or swelling (foot), ask your child first if he has hurt himself doing any of the normal child activities or sports. Chances are it just might be a sprain.

If you are still quite unsure, do remember that the symptoms of gout in children are the same as that of any adults. If you have taken almost every precautionary measure and still doubt what your child has, consult with a qualified physician as soon as possible and check for causes not related to eating unhealthily or indulging in high-purine foods.

Celery Seed Extract for Gout: What You Need to Know

Celery has long been associated as a remedy for gout. If you plan on trying out this alternative form of treatment, we feel you need to know at least some basic truths behind it, or if there is in fact any scientific hypothesis linked to its medicinal capabilities.

But first, when we say celery, do we mean celery seeds, seed extracts, or the whole celery (including leaves and barks)? Being that this article is centered on “seed extract,” we need to single out the one thing unique to celery that is responsible for its healing powers—3-N-butyl-phthalide. Although common to the whole plant—responsible for giving celery its unique taste and odor, 3-N-butyl-phthalide, or 3nB for short, is concentrated in the plant’s seeds. The compound was discovered to have natural diuretic properties which can help lower blood pressure. Taking from it being a “blood purifier,” doctors became curious as to whether it can treat rheumatic diseases such as arthritis, osteoporosis and arthritis (and of course, gout).

A small-scale study was conducted involving 15 patients who have had continual pain symptoms of osteoarthritis and osteoporosis for over 10 years. Each were given 34 milligrams of celery seed extract with at least an 85% concentration of 3nB twice daily. The results were significantly positive and the earliest signs of pain relief happened in only three weeks for some subjects. Reduction in pain ranged from 68% to a complete 100% recovery for those who continued to take the extract for six weeks.

Taking from the pilot study, a larger study involving 70 patients was conducted. Each was given 75 milligrams of celery seed extract twice daily for three weeks. The higher dosage in this larger study showed even better results than in the original study. No side effects other than the diuretic effect were recorded in both studies. Sodium and potassium balance remained the same.

In addition to our interest in all of this (as a gout publication), they have concluded that 3nB appears to lower the production of uric acid by inhibiting xanthine oxidase–an enzyme that catalyzes the oxidation of xanthine to uric acid, or an enzyme that is involved in the metabolism of purines. Common prescription medication for gout include xanthine oxidase inhibitors such as allopurinol.

Basing from what we’ve learned so far, celery seed extract can control the symptoms of gout by providing pain relief and limiting the production of uric acid. Depending on how you see it, it can be a cure if taken continuously, but does not provide fast pain relief.

Now, when people say “celery seed extract,” especially with regards to gout, they are referring to those in tablet or capsule form (filled with celery seed oil). The good thing about these made-easy-to-ingest forms is that the amount of 3nB is already set to its maximum recommended level. Really, it would be next to impossible guessing how much 3nB you’re consuming just by eating celery. As a starting dosage for gout, take two tablets twice daily. Do not take more than three tablets daily. Ask your doctor before giving them to children below 18 years. Observe pain relief after a couple of weeks.

The First Signs of a Gout Attack: A Personal Account

Being a publication devoted solely to a single ailment, we often work under the assumption that most of our readers are, like us, gout veterans. However, gout will always claim new victims, and for these “rookies,” the unfamiliar changes one’s body goes through can be quite overwhelming. Needless to say, it is important to catch these early signs and symptoms of gout—one, to prevent further damage, and two, to be in the know (that at least what you’re going through is not “that” serious).

Let me speak from experience. I’ve often shared my personal love-hate relationship with gout in this blog, but as a refresher, here’s a quick summary: I had my first attack in 2008; I’ve had 5 to 6 minor episodes since then, and I’ve only had it on my left big toe. Now, going back to that dreadful bout in 2008, the following is an account of what happened—prior to knowing for sure that it was in fact gout that hit me.

It took me about a day and a half before I went to a doctor; the diagnosis was quite routine for her, and I honestly think she knew just by seeing me walk through her office. But let’s go back the to days leading to that check-up.

In the middle of an uneventful day, I noticed an unfamiliar feeling on my left big toe. It wasn’t painful or anything, but it was non-normal enough that I couldn’t deny it, not to mention not notice it. I retired early that day because we had something big planned the next day. Upon waking up, I couldn’t help but notice that the feeling was still there. No worries though, it was still not painful, but I could tell that the feeling became more obvious. Unfortunately, the “big day” we had planned involved a lot of walking—a visit to a theme park of sorts. I wore my regular non-athletic sneakers (with socks), and as the day progressed, I started to develop a limp. I remember describing the feeling as sort of sprain-like—I think sprain was the only other injury I’ve ever had on my foot which is probably why. As the day turned to night, my shoe felt tighter and tighter (because of the swelling). Nearing the end of our activity, I remember telling my then-girlfriend-now-wife that I’d sit the souvenir shopping out. Time finally came to go home and had we not brought an automatic car I would’ve asked her to drive.

Back at home I removed my shoe and saw that my foot was swollen. The swelling was not out of this world or anything, or at least that was what I wanted to think. I showed it to my mom and my sister and they were more surprised than I was. “That is really swollen” or something to that extent were their responses. My mom suspected it was gout because as it turns out, she was all too familiar with the ailment because of my late father. I think it was because they noticed it, and maybe even because I had heard the word “gout,” but after that the pain started to get out of hand. To this day, I often hear anecdotes that even the slightest touch—in particular, bed sheets—can make the pain even worse. To tell you the truth, I do remember removing my blanket altogether and elevating my foot with a pillow—all the while warning anyone who goes near it will die.

The day following that was when we visited the doctor. I shared part of my experiences during the healing stage in this post, but as far as the title of this post is concerned, I have to end here. I hope I was able to shed some light on what you might be experiencing right now, and don’t fret, gout is quite manageable. You’ll live.

Cherry juice as a remedy for gout

Gout diet lists have one thing in common: they all recommend eating foods that, in plural form, end in “ies”. Strawberries, blueberries, and of course, for the sake of this article, cherries. However, let’s somehow limit the focus of this text and only talk about cherries in an easier-to-digest form: juice.

Of all the available natural gout remedies, cherry juice sparks a bit more interest because of its accessibility and availability; perhaps more importantly, its taste (and the fact that it seems like one is allowed to “indulge” on something). So, the question remains, how does cherry juice really help gout victims? And, is it a valid remedy?

Unlike most folkloric and anecdotal remedies for gout, the use of cherries has been backed by a number scientific studies. However, its discovery was somewhat accidental. Back in the 1950s, a gout-suffering doctor by the name of Ludwig W. Blau was forced to eat the only food left in his house—a bowl of cherries. After going through them all, he found out the next day that his gout symptoms were significantly reduced. He continued eating cherries and remained gout-free until he stopped. Amazed with his luck, he sought help from a local physician and devoured some locals (with arthritis or gout) to embark on a similar cherry diet. Needles to say, the results were positive and they published a report entitled “Cherry diet control for gout and arthritis“.

For more recent studies, you can also check out the one conducted by the European League Against Rheumatism, discussed in detail in this article.

Common to all the studies conducted is the fact that cherries do not lower uric acid levels. It does not attack gout that way, but rather, alleviates the swelling caused by the formation of uric acid crystals in joints. The anti-inflammatory properties of cherry is attributed to anthocyanins—antioxidant compounds which also give cherries their bright red color. The same effect—and in fact, a little better—can be had from taking non-steroidal anti-inflammatory drugs such as indomethacin, but like most medications have adverse side effects. With cherries, you get an all-natural, whole food alternative.

How to take cherry juice for gout – dosage

As a starting dosage, you can try two glasses of cherry juice per day—one in the morning and one before retiring to bed—by diluting a tablespoon of cherry juice concentrate with water. Cherry juice concentrates can be found on most groceries; stay away from concentrates that are branded as “medicines” with claims of curing gout and arthritis. Remember, this is only a harmless alternative remedy so do not expect too much to avoid getting disappointed for lack of results.

Hot or cold compress for gout?

There seem to be opposing opinions regarding this one; however, since it involves contradicting ideas, the issue should at least be clarified. Going back to the question, the real answer would be that there is no one true answer.

First, let me speak from experience. Yes, being that I’m a webmaster of a gout site, I really do have experience with this ailment. My first attack happened three years ago. Since that time, I’ve had four to five additional (but relatively minor) episodes. During the the first one, the most painful one, I consulted with an orthopedic surgeon. In the original post on my personal blog, I shared the medications prescribed to me, and I also wrote that I was told to dip my foot (big toe gout) thrice a day in icy water. I do remember doing this but by that time the pain was already at about 50% so I couldn’t tell if it relieved the pain much.

Next, the information scattered over the internet—with the exact same text, copy-pasted—tells us to alternate between hot and cold. They say this dissolves the uric acid crystals. The method goes as follows: hot with a heated towel or bucket with warm water for 30 minutes, then cold with an ice pack or icy water for 30 seconds. Alternate continuously for 20 minutes but always end with cold.

The only other sensible article I read regarding this recommends cold compress. Coming from the doctor who wrote the article, he says that he recommends ice packs on arthritis patients (gout is a form of arthritis) to minimize inflammation and reduce pain. However, he also says that warm compress can also work especially at the start of the day to relax muscles surrounding the affected joint. At the end of the day, going back to the ice pack relieves the (new) inflammation caused by daily activities.

Gout, unlike in an injury, does not involve muscle tissues breaking. In an injury, a cold compress is used (without doubt) to close broken capillaries to stop blood from flowing through. During the healing stage, when the capillaries are closed, hot compress is then used to relax surrounding muscles.

Gathering from what I’ve read so far, in gout, cold compress is used to relieve pain caused by inflammation, and alternating between warm and cold compress dissolves uric acid crystals.