"Studies on the Nature of Gouty Tophi" by Max Freudweiler, 1899

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Abstract
The following pathological processes are attributed to true gouty tophi: Sodium-biurate deposited in the tissue induces a highly reactive inflammation because of its chemical structure with resulting toxic effect upon living tissue; this is recognized by inflammatory cellular infiltration and tissue swelling. It is unlikely that tissue necrosis precedes crystal deposition as sodium-biurate can cause complete tissue necrosis. Needle-shaped crystals are found in anatomically intact tissue. When gouty tophi regress, phagocytic cells are active in the process; at present we have no clue to suggest that a physical or chemical action of body fluids is operative. Reorganization of the tissue defect is by centripetal proliferation of surrounding connective tissue; this also forms a tough fibrous capsule around the crystals, decelerating their interaction with the original surrounding tissue, so that finally they can be removed completely.

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