Tophus severity grading and surgical treatment: Chinese medical doctor association multidisciplinary expert consensus statement and recommendations, 2025

Background: Tophi, a severe complication of advanced gout, develop in approximately 12–35% of patients with gout, with rates as high as 52.56% being reported. Bone and joint damage and chronic refractory wounds caused by gouty tophus present considerable clinical challenges. However, the optimal surgical timing, perioperative management, and treatment approaches for this condition remain unstandardized. Therefore, an expert consensus statement was developed to provide guidance for surgical intervention and improve clinical management of gouty tophus. Materials and Methods: A multidisciplinary expert committee representing relevant clinical specialties was established, and key questions on tophus surgery were compiled. Eleven scientific literature databases were queried to retrieve relevant papers, and a literature quality assessment was performed. Four meetings (nominal group technique) and two Delphi voting rounds were conducted to define tophus erosion grading criteria and establish recommendations. Consensus was considered to have been achieved when at least 85% of panelists indicated agreement. Perspectives from two patients with tophi were incorporated through interviews. Results: Grading criteria (grades 1–4) for tophus erosion damage were established, and 14 recommendations for surgical treatment (eight strongly recommended and six conditional) were formulated—two on determining tophus erosion severity, four on perioperative management, and eight on surgical indications and treatment. Conclusion: This study presents the first consensus to introduce standardized criteria for grading tophus severity through multidisciplinary collaboration and offers evidence-based recommendations on optimal surgical timing, perioperative management, and treatment strategies to enhance patient outcomes and guide clinical practice. These recommendations may serve as a foundation for future research and standardization efforts in the surgical management of gouty tophus globally.