OBJECTIVES: Describe patient characteristics and healthcare resource utilization (HRU) in gout patients with and without tophi. METHODS: Data were assessed from detailed/systematic patient chart audits from October 2012. Category and dose of urate lowering therapy and patient characteristics were identified.  Comparisons were between patients with and without tophaceous gout. Patient characteristics, comorbidities, HRU, serum uric acid, and use of colchicine during the 12-month study were compared using chi-square or Fisher’s Exact tests. RESULTS: Patient charts were abstracted from 125 primary care physicians and 125 rheumatologists. Of 1159 patients, 273 (23.81%) had tophaceous gout. Patients with tophi had gout for a longer time (66 vs. 39 months; p<0.001), reported more flares (2.5 vs. 1.8 per year; p<0.001), and were more likely to have joint damage (43.6% vs. 6.6%; p<0.001). Patients with tophi were more likely to have higher rates of cardiovascular disease (p<0.001), chronic obstructive pulmonary disease (p<0.001), congestive heart failure (p<0.001), diabetes (p=0.011), depression (p=0.004), hypertension (p<0.001), osteoarthritis (p<0.001) and kidney stones (p=0.002). Patients with tophi were more likely to be treated with a urate-lowering therapy (94.1% vs. 68.0%; p<0.001), take colchicine (38% vs. 30%; p<0.001) and steroids (69% vs. 36%; p<0.001), and less likely to take NSAIDS (38% vs. 54%; p<0.001). Few patients with and without tophi achieved serum uric acid <6mg/dL and no flares (10% vs. 11%; p=0.50); and a greater proportion of patients with tophi had a gout-related emergency visit (19.8% vs. 7.5%; p<0.001) or had gout-related surgery (3.3 vs. 0.0; p<0.001). CONCLUSIONS: Patients with tophaceous gout have significantly greater burden of disease, and higher frequency of comorbidities and HRU than patients with non-tophaceous gout. Preventing the development of tophi or resolving crystal burden by treating to guideline targets remains a rarely achieved goal for patients with and without tophi.