Gouty Tophi Excision: Bridging Modern Surgery and Ayurvedic Wisdom

Abstract

Gouty tophi are a hallmark of chronic gout, resulting from the deposition of monosodium urate (MSU) crystals in tissues, leading to granulomatous inflammation. Chronic tophaceous gout typically develops in long-standing hyperuricemia and may cause pain, deformity, infection, and functional impairment, often necessitating surgical intervention. From an Ayurvedic perspective, gout corresponds to Vatarakta, a condition involving an imbalance of Vata Dosha and Rakta Dhatu. Chronic cases with deeper joint involvement are classified as Gambhira Vatarakta. Management strategies include dietary regulation, detoxification therapies (Panchakarma), and herbal formulations aimed at reducing uric acid levels and inflammation. This case report presents a 59-year-old male with a 15-year history of hyperuricemia and progressive tophaceous swellings on his left foot, complicated by pain and pus discharge. Clinical examination revealed elevated uric acid levels (8.3 mg/dL). Surgical excision of the tophus at the fifth metatarsophalangeal (MTP) joint was performed under local anesthesia, resulting in symptom resolution. This case highlights the importance of early gout management to prevent chronic progression. While surgery provides effective symptomatic relief, long-term control of hyperuricemia through pharmacological, dietary, and Ayurvedic approaches remains essential to prevent recurrence and joint damage.