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Chronic Gout Without Tophus

Truly, gout has many mysteries. Most of them are unsolved, some are unanswered because we fail to recognize the root, or at least we fail to accept a paradigm shift. One such mystery of gout is how a person gets chronic gout without tophus.

Gout for the first timers

Surely, when a gout sufferer comes to the doctor for the first time, the doctor can tell the situation right away. Without using any instrument and without any laboratory analysis, the inflammation and pain alone can lead the doctor to immediately and conclusively say that “Hey, that is gout”.

But what if there is no inflammation at all? In this case, it will be harder to identify gout. And YES, it is possible to have chronic gout without tophus. In fact, gout can differ from patient to patient. One can have tophus without pain, some can have pain with swelling while others can have pain without both swelling and tophus.

Chronic Gout

Chronic gout, by the name itself, is EVERLASTING GOUT (or at least, that is what most people believe). Chronic gout can be caused by several factors. For instance, it can be caused by the destruction of the joints as tophus enlarges. At first, the ligaments and joint surface are damaged. As time passes by, the joint is slowly chipped away by the constant contact of the joints and the tophus crystals. Such damage is almost irreversible, that is why it is CHRONIC.

Chronic gout can also be caused by the genetic disease Lesch-Nyhan Syndrome, a deficiency of the HPRT gene which has a vital function in the conversion of purine to uric acid.

Chronic Gout Without Tophus

It is ironic to think that gout happens without swelling. The more ironic part is gout can attack even if you have low uric acid in your urine and blood! So how does this happen? Do you know the common metaphor of the iceberg? Only 10% of the iceberg is visible, the rest is submerged underwater. It is usually applied to the conscious and subconscious mind, but we can apply this to gout as well. Only a portion of the disease is obvious, the rest is hidden. This includes the volume of the uric acid. 

Truly, there can be little uric acid in urine and blood, BUT uric acid can be present deeper inside. Uric acid can be present in the interstitial fluids, and may have even settled within the synovial fluids in the ball-and-socket joints. In short, the absence of protruding white crystals in the joints, ears and other parts of the body that there is no tophus present at all. Tophi exists, but they do not protrude. They exist as small crystals deposited in the joints. The pain has deeper roots! Chronic gout without tophus is a myth. The more appropriate term is “Chronic gout with invisible tophus”.

Even if the crystals are small, it is regarded as a threat by our body. The immune system sends in an army of neutrophils to neutralize the invader. Unfortunately, the neutrophils will fail to do so because they are not designed to combat inorganic substances. Because of this, the neutrophils’ warcry are replaced with request for assistance, which is pain, your body’s way of saying that “Hey! Something is not supposed to be there”. Sadly, no matter how hard you bang your knees, ankle or whatever joint is affected, pain will not go away. No matter how much you desire to turn your joints inside out to be able to grab the tophus and just throw them away somewhere far away from the reach of civilization, you can not.

Curing Chronic Gout

Now, back at the “Everlasting Gout” part. Are we to accept that chronic gout is indeed chronic? Of course not! No one wants to eternally suffer from the restraining pain of this notorious disease. It is true that we cannot control our genes, BUT genes are not the sole factors that contributes to gout.
There is something YOU CAN DO. Yes, YOU. Not your doctor, not your homeopath or not any medical expert out there. A choice to be made by YOU, and YOU alone.
Understand Your Gout


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