Treatment of tophaceous gout: When medication is not enough.

Objectives: To review the literature concerning surgical intervention of tophaeceous gout and propose clinical circumstances for when it may be considered.

Introduction: Tophi develop in approximately 12-35% of patients with gout. Tophaceous disease is usually preventable given the availability of effective urate lowering therapies (ULT) including allopurinol, febuxostat, probenecid, lesinurad, and pegloticase.