OBJECTIVE: To examine the association of alcohol consumption with the presence and development of ultrasound (US)-detected tophi and subcutaneous tophi (sub-tophi) in a Chinese gout population. METHODS: A total of 554 patients with gout who underwent US and physical examination on the most frequently involved joints in gout were included. Multivariable analysis was performed to assess the associations of the duration, quantity, and type of alcohol consumption with the presence, size, and number of US-detected tophi and sub-tophi. RESULTS: Compared with non-drinkers, excessive drinkers (>70 g/week), long-term drinkers (≥10 years) and spirits drinkers had a greater proportion, size, and number of US-detected tophi and sub-tophi (all P < 0.05). After adjusting for confounders, excessive drinking (> 70 g/week) (odds ratio [OR]: 1.79; OR: 2.00), long-term alcohol consumption (≥ 10 years) (OR: 1.96; OR: 2.17), and spirits consumption of (OR: 1.81; OR: 2.10) were significantly associated with the presence of US-detected tophi and sub-tophi (all P < 0.05), with the highest OR among the identified risk factors. Among patients who already have US-detected tophi or sub-tophi, moderate drinking (≤ 70 g/week) was associated with larger or multiple tophi (all P < 0.05). CONCLUSION: A longer duration and higher quantity of alcohol consumption as well as spirits consumption are predictors for the development of US-detected tophi and sub-tophi in patients with gout. Among people who have US-detected tophi and sub-tophi, weekly alcohol consumption leads to the development of tophi regardless of amount consumed. This article is protected by copyright. All rights reserved.