[Medical Q&A] Can tophi grow in the ears?

Planner: Chinese Medical Association

Reviewer: Shao Zengwu, Chief Physician and Professor of Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology

Gout stones can also develop in the ears.

Gouty arthritis is a series of acute and chronic inflammatory diseases of the joints caused by gout. In the early stage, it is recurrent acute arthritis with hyperuricemia, and in the late stage, it may cause joint deformity and dysfunction due to chronic arthritis, bone destruction, and tophi formation.

During the gout symptom period, arthritis can be divided into acute and chronic. In the acute stage, the disease often occurs suddenly at night or in the morning, often with high-purine diet intake, drinking, excessive fatigue and other predisposing factors. Most of them are monoarthritis, which is common in the metatarsophalangeal joints of the toes, and can also occur in the ankles, knees, other joints of the feet, as well as elbows, wrists, and hands. Those with repeated attacks may have polyarthritis. In the chronic stage, tophi may form beside the joints or in the ear and nasal cartilage, and white urate crystals may overflow after ulceration.

The treatment of gouty arthritis includes non-drug treatment, drug treatment and surgical treatment. Non-drug treatment includes controlling diet, reducing or prohibiting the intake of high-purine foods, avoiding alcohol, and drinking plenty of water. In terms of drug treatment, oral or slow intravenous injection of colchicine in the acute phase can significantly relieve the patient's pain symptoms. Drugs that lower uric acid should not be used in the acute phase, because they can cause tophi to dissolve, thereby aggravating joint inflammation. In the chronic phase or between attacks, patients can be given drugs that inhibit uric acid synthesis or accelerate uric acid excretion. Acid-suppressing drugs such as allopurinol can be used, and acid-excreting drugs such as probenecid and benzbromarone can be used. For patients who are ineffective with conservative treatment and whose tophi affect their daily life (such as wearing shoes), surgical stone removal is recommended. If combined with deformity or joint dysfunction, orthopedic surgery such as joint replacement is recommended.