Conclusions
Tophaceous disease occurs early in the course of gout in approximately 15% people. The presence of tophi is strongly associated with features of chronic joint inflammation, pain and activity limitation. Creatinine clearance is independently associated with the presence of subcutaneous tophi in people with recent onset gout. Prospective longitudinal studies are needed to address the relative importance of chronic kidney disease, urate burden and other risk factors in the development of tophi in people with gout.