Abstract: Systems and methods for assessment of the reduction of tophus burden with effective urate-lowering therapy were developed. The first application of computer-assisted methods for accessing tophus response included standardized digital photography, computer assisted measurement and analysis of tophi by an independent reader and blinded central reader paradigm. The ability of the method for computer-assisted analysis of digital photographs to quantify reduction in tophus size demonstrates its feasibility as a urate-lowering therapy monitoring tool in the treatment of tophaceous gout.