Tophi deposition is most characteristic of which gout stage?

• A. Chronic tophaceous gout
• B. Acute gout
• C. Intercritical gout
• D. Asymptomatic hyperuricemia

Answer: (A)

Tophi deposition is a late feature of gout, reflecting long-standing hyperuricemia with urate crystal accumulation in soft tissues. When uric acid remains elevated for years, crystals form nodules—tophi—that are surrounded by a granulomatous inflammatory response. These nodules commonly appear in the ears, elbows, fingers, and other soft tissues, and they can erode adjacent bone and joints over time. This makes chronic tophaceous gout the stage most characterized by tophi. In contrast, acute gout involves sudden inflammatory attacks without tophi, intercritical gout refers to the symptom-free intervals between attacks (where tophi may not yet be present), and asymptomatic hyperuricemia means high uric acid without joint symptoms or tophus formation.