People who have repeated attacks of gout or persistent hyperuricemia for many years can develop tophaceous gout. This designation describes the accumulation of large numbers of urate crystals in masses called tophi. These tophi develop in joints, bursae, bones, and cartilage, or under the skin. Tophi may cause erosion of the bone (marginal erosions) and eventually joint damage and deformity.
The presence of tophi near the knuckles or small joints of the fingers can be a distressing cosmetic problem. Tophi are usually not painful or tender but they can become acutely inflammed.