According to Prof. Dr. Ly Mong Dao, Head of the Rheumatologist Association of the Chinese Medical Association, Head of the Department of Musculoskeletal and Immunology, Hiep Hoa Beijing Central Hospital, prolonged high uric acid can cause urate crystals to accumulate in the body and form tophi particles. These crystals not only cause inflammation but also directly destroy joint structure, leading to deformity and limited movement.
Tophi particles often appear in positions around joints, especially toes, feet, fingers, elbows, or earlobes. Initially, they may be small and less uncomfortable, so patients easily overlook them.
However, when uric acid continues to be high, the amount of accumulated urate crystals may increase. Tophi seeds are therefore tending to grow larger, and prolonged chronic inflammation of the joint can cause damage to the joint structure.
According to Assoc. Prof. Dr. Truong Trac Ly, Head of Rheumatoid Arthritis and Immunology Department, Peking University People's Hospital, common gout patients need to maintain blood uric acid below 360 μmol/L. For people who already have tophi granules, the disease recurs many times or has serious complications, the control target needs to be stricter, below 300 μmol/L.
This shows that pain relief after a gout attack does not mean the disease has been controlled. In the interphase of pain, urate crystals can still continue to deposit if uric acid has not reached the target.
A common mistake is that patients only focus on abstaining from purine-rich foods and ignore long-term treatment. Assoc. Prof. Dr. Truong Trac Ly said that lifestyle and diet changes are fundamental, but adjusting the diet alone usually only helps reduce about 10-20% of uric acid. Most uric acid in the body is also related to the endogenous metabolism process, so many patients still need anti-uric acid drugs to achieve the treatment goal.
Dr. Luu Yen Ung, Head of Rheumatoid Arthritis Department, Beijing Friendship Hospital, also warned that if gout is not controlled, recurrent arthritis episodes can lead to the formation of tophi granules, even causing joint deformities. Uric acid can also affect the kidneys, increasing the risk of kidney stones and gout-induced kidney disease.
Therefore, people with tophi granules should not wait until pain occurs to be treated. Long-term uric acid control, maintaining a proper diet, limiting alcohol and sugary drinks, weight control and periodic check-ups are important factors to help limit disease progression.
The sooner tophi seeds are detected and the more targeted uric acid is controlled, the more chances patients have to prevent joint damage from continuing to progress. For people with tophi seeds, treatment goals are often stricter and need to be assessed by a specialist doctor, instead of self-adjusting medication or relying solely on diet.
