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In addition, in patients with long-standing disease or advanced age, mixed deposition of calcium pyrophosphate dihydrate crystals may alter dissolution kinetics and further destabilize the tophus environment ( 9 Potential therapeutic strategies for tophi As a defining feature of advanced gout, tophus formation reflects a complex pathophysiological process driven by the combined influences of MSU crystal deposition, chronic inflammation, and fibrotic tissue remodeling