How to Remove Gout Crystals From the Joint

Cory Martin
·4 min read

Medically reviewed by Marissa Sansone, MD

If you’ve been diagnosed with gout, you know that it can be an extremely painful condition. You may also wonder how gout crystals can be removed from your joints to relieve the pain.

It is possible to reduce the number of gout crystals in your joints with certain prescription medications, Certain lifestyle measures may also be helpful. If gout crystals become very painful or disabling, surgical methods may be necessary to relieve pain, avoid infection, or restore mobility.

This article explains what gout crystals are, what causes them to build up and form painful nodules, and how they can be treated.

How Do Grout Crystals Develop?

When purines—substances found in certain foods like red meat, dried beans, and alcohol—break down in the body, it causes uric acid to form. The uric acid then passes through the kidneys and out of the body in the urine.

With gout, however, the uric acid can accumulate and form needle-like crystals called tophi that deposit in the joints and cause pain. Untreated gout or gout that has progressed can become chronic tophaceous gout. When this occurs, painful nodules can form and interfere with the ability to perform daily activities.

Related: An Overview of Tophi in Gout

How to Get Rid of Gout Crystals

Treating gout tophi requires a comprehensive plan. Your healthcare provider may prescribe medication and will also talk to you about lifestyle modifications.

The object of treatment is to maintain your health and quality of life. Staying active and seeking guidance for the types of activity that are best for you and your joints can also help you live well with gout.

Related: How Gout Is Treated

Home Remedies

Lifestyle measures that can help reduce the buildup of uric acid in your body include:

  • Reducing your consumption of purine-rich foods, such as organ meats and red meat

  • Cutting back on alcohol, especially wine and beer

  • Losing weight, if necessary, to reduce pressure on your joints

  • Exercising, choosing low-impact activities such as walking and swimming that are easy on the joints

  • Staying well-hydrated (by drinking at least eight 8-ounce glasses of water per day) to help flush uric acid out of your system

Medications

Your healthcare provider may prescribe medications to lower the amount of uric acid in your blood to dissolve crystals and prevent new ones from forming. These include:

  • Zyloprim (allopurinol): This drug reduces the body’s uric acid production.

  • Uloric (febuxostat): This medication also reduces the body’s uric acid production. It is primarily prescribed to people who cannot tolerate allopurinol.

  • Krystexxa (pegloticase): Krystexxa is a biologic drug that works by converting uric acid into a substance called allantoin, which your body can easily eliminate. It is administered intravenously every two weeks at a clinic and is therefore reserved for only the most severe cases.

Surgery

If you have gout tophi that do not decrease in size and continue to cause pain and disability even with treatment, your healthcare provider may suggest surgery.

You may need surgery for impaired function, nerve compression, infection, joint instability, significant pain, and skin ulceration. Ulcerated gouty tophi are prone to infections. Surgery is considered when infection occurs and when there is a risk of sepsis.

There are several surgical options for gout tophi, including:

  • Shaver technique: Intra-lesion shaving is done by making multiple small incisions in the skin to allow direct access to the tophic mass. Suction and irrigation are performed simultaneously to remove the chalky deposits of sodium urate.

  • Full surgical removal: The tophi may be fully cut out from the joint as much as possible without destroying the surrounding tissue. Removal of gouty deposits and nodules occurs at this time as well.

  • Joint fusion: If the joint is unstable and damaged by the tophi, joint fusion may be recommended. Smaller joints will be fused together to limit movement and reduce pain.

  • Joint replacement: If the gout tophi cause irreversible damage to the joint, you may need a total joint replacement, such as in the knee or hip to restore function and reduce pain.

Outlook

Gout is a chronic condition that can flare up when new gout crystals form. With medications that control uric acid buildup, it can take six to 12 months after the uric acid level is suppressed below 6.0 mg/dl for symptoms of gout to stop. Still, lifestyle measures are necessary to keep uric acid levels under control.

Summary

Gout is a painful arthritic condition caused by a buildup of uric acid in the body. When there is excessive buildup, needle-like crystals called tophi can form in the joints. Left untreated, these can lead to painful nodules. It is possible to dissolve these crystals and prevent new ones from forming with dietary and lifestyle measures and medications. In rare cases, surgery may be necessary to treat gout.

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