resorbtiion of uric acid from tophi

[MisterEd]

I just had surgery to remove “the largest tophus I have ever removed” from my elbow/forearm. I am delighted with the lack of pain (from the surgery) the fear of which had caused me to procrastinate for years. I thought I'd be out of the gym for a month or more – a real setback, but I now think after less than a week that I'll be lifting again next week.

Question: Any info on the idea that the tophi present a source (reservoir) of (pre-) Uric Acid to the body? If so, I would expect mitigation of the gout by removing this sucker. I've heard yes and no answers to this. The surgeon was intrigued by the question but unsure. I think he was skeptical, but I did read somewhere that it could be resorbed.

Allopurinol has never been very effective for me. I did have the “rich food lifestyle”, so maybe I was not doing the best I could. I have lost 60+ pounds and work out almost every day with fairly heavy weights (heavy for an older guy). I dropped from 280+ to the 220's and feel much better (obviously). But the best part is no acute attacks. I've had them in knees, fingers, elbows and feet, not just toes. I have also passed to the chronic phase (my characterization) which means significant discomfort over long periods of time in addition to the occasional paroxysm. Anyone else like this?

Thanks

[zip2play]

Hi Mr. Ed,

I guess you are one of my neighbors (NYC area.)

The way the body seems to handle long term gout is to isolate most of the urate in a sealed pouch slightly outside a joint and isolated from the bloodstream. If this is COMPLETE it has no more effect on the body than would an impacted stone. With no experience of surgical tophus removal but some idea of how bizarrely they can be shaped my guess is that no surgwon could get all of it out without gross overcutting. So I would expect the surgery to result in a lot of temporary re-migration of whatever was left in on a near microscopic level. A nicety is that since the body dopes such a nice job in moving the tophi bulk OUT of the joint, surgical removal of the tophus can be done without manging the joint…and thus a quick return to real life.

In English I think you will have more pain rather than less on a temporary level.

I also think that if you had one BIG one removed, you have dozens of smaller ones hiding 'round.

Tell us about your allopurinol use. (I think you are goiing to need it now more than ever.)

[Author]

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