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GOUT CAUSES SMOLDERING INFLAMMATION AND TISSUE DESTRUCTION^1-4

Monosodium urate deposits cause local chronic inflammation even after the resolution of a flare. As documented by Professors Nicola Dalbeth, MD and Georg Schett, MD, this chronic inflammation is indicated by synovitis and the ongoing presence of macrophages and plasma cells. It can also cause joint damage and tissue destruction.^1-4

Professor Georg Schett, MD
Erlangen, Germany

Photo of Professor Georg Schett, MD, Rheumatology

Professor Nicola Dalbeth, MD
Auckland, New Zealand

Photo of Professor Nicola Dalbeth, MD, Rheumatology

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"Both the monosodium urate crystals and the host inflammatory response contribute directly to bone erosion."

– PROFESSOR NICOLA DALBETH, MD

THE CYCLE OF DESTRUCTIVE INFLAMMATION IN GOUT^1-4

Inflammation is initiated¹

MSU crystals trigger acute inflammation¹

Inflammation promotes destructive cellular behavior^2,3

Osteoclast-like cells accumulate at the bone-tophus interface³
Cartilage cells signal to break down key components of cartilage^2-4

Cellular death leads to increased local levels of uric acid^1-3

DNA from dead cells breaks down into uric acid³

Uric acid triggers further inflammation¹

Apart from acute flares and acute gout attacks, there is also a kind of smoldering inflammation, which is associated with swelling and pain, which is typical for tophaceous gout patients.
– PROFESSOR GEORG SCHETT, MD

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REFERENCES

Schett G, et al. RMD Open. 2015 Aug 15;1(suppl 1):e000046.
Dalbeth N, et al. Arthritis Rheum. 2010;62(5):1549-1556.
McQueen FM, et al. Nat Rev Rheumatol. 2012;8(3):173-181.
Liu-Bryan R, et al. J Immunol. 2005;174(8):5016-5023.

Additional resources

AMERICAN COLLEGE OF RHEUMATOLOGY (ACR) GUIDELINES FOR MANAGEMENT OF GOUT

Is your sUA goal low enough to effectively reduce the signs and symptoms of gout and resolve tophi? Review the 2012 ACR guidelines to see if your gout treatment goals line up with industry recommendations.

Review ACR guidelines

CELLULAR CHARACTERIZATION OF THE GOUTY TOPHUS: A QUANTITATIVE ANALYSIS

Professor Nicola Dalbeth, MD’s 2010 article in Arthritis & Rheumatology details her team’s study of the cellular architecture of tophi, and how the cells present in the corona and fibrovascular zones of a tophus may contribute to a cycle of chronic inflammation.

Read the article