GOUT CAUSES SMOLDERING INFLAMMATION AND TISSUE DESTRUCTION1-4

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 George Schett, MD
Professor Georg Schett, MD
Erlangen, Germany
Professor Nicola Dalbeth, MD
Professor Nicola Dalbeth, MD
Auckland, New Zealand

“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 GOUT1-4

Inflammation is initiated1

MSU crystals trigger acute inflammation1

Inflammation promotes destructive cellular behavior2,3

Osteoclast-like cells accumulate at the bone-tophus interface3
Cartilage cells signal to break down key components of cartilage2-4

Cellular death leads to increased local levels of uric acid1-3

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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Additional resources

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

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.

CELLULAR CHARACTERIZATION OF THE GOUTY TOPHUS: A QUANTITATIVE ANALYSIS

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.

Bone erosion Bone erosion

WHAT HAPPENS AFTER A FLARE

Professor George Schett, MD examines how pain resolution can mask an ongoing problem in gout.

Review the research
Uric acid Uric acid

WHAT YOU CAN DO

Learn about a treatment option for chronic gout.

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References

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