Sometimes, tophi break through the skin and appear as white or yellowish-white, chalky nodules.

The development of gouty tophi can also limit joint function and cause bone destruction, leading to noticeable disabilities, especially when gout cannot successfully be treated.

[2] When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid (e.g., allopurinol, febuxostat) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout (RCG).

It appears that monosodium urate crystals trigger a distinct physiological NETosis pathway that coats them in DNA.

These coated crystals then persist in tissues as a foreign body granuloma constituting gouty tophus.