Skip to main content
SpringerLink
Log in

Gout

  • Chapter
Primer on the Rheumatic Diseases

Abstract

Gout is a clinical disease associated with hyperuricemia and caused by the deposition of monosodium urate (MSU) crystals in and around the tissues of joints. Symptomatic crystal deposition includes attacks of acute inflammatory arthritis, a chronic destructive arthropathy, and soft tissue accumulation of MSU crystals. The nonarticular (soft tissue) clinical manifestations of gout include the development of tophi (Figure 12A-1) and the precipitation of crystals in the renal collecting ducts, leading to urolithiasis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia: risks and consequences in the Normative Aging Study. Am J Med 1987;82:421–426.

    Article  CAS  PubMed  Google Scholar 

  2. Sydenham T. The whole works of that excellent practical physician, Dr. Thomas Sydenham. 7th ed. Pechey J. trans. London: Feales; 1717:17.

    Google Scholar 

  3. Ho G, DeNuccio M. Gout and pseudogout in hospitalized patients. Arch Intern Med 1993;153:2787–2790.

    Article  PubMed  Google Scholar 

  4. Pascual E. Persistence of monosodium urate crystals and low-grade inflammation in the synovial fluid of patients with untreated gout. Arthritis Rheum 1991;34:141–145.

    Article  CAS  PubMed  Google Scholar 

  5. Wernick R, Winkler C, Campbell S. Tophi as the initial manifestation of gout: report of six cases and review of the literature. Arch Intern Med 1992;152:873–876.

    Article  CAS  PubMed  Google Scholar 

  6. Popp JD, Bidgood WD, Edwards NL. Magnetic resonance imaging of tophaceous gout in the hands and wrists. Semin Arthritis Rheum 1996;25:282–289.

    Article  CAS  PubMed  Google Scholar 

  7. Popp JD, Bidgood WD, Edwards NL. The gouty tophus. Rheumatol Rev 1993;2:163–168.

    Google Scholar 

  8. Hench PS. The diagnosis of gout and gout arthritis. J Lab Clin Med 1936;22:48–55.

    Google Scholar 

  9. Nakayama DA, Barthelemy C, Carrera G, et al. Tophaceous gout: a clinical and radiographic assessment. Arthritis Rheum 1984;27:468–471.

    Article  CAS  PubMed  Google Scholar 

  10. McGill NW, Dieppe PA. The role of serum and synovial fluid components in promotion of urate crystal formation. J. Rheumatol 1991;18:1042–1045.

    CAS  PubMed  Google Scholar 

  11. Ziff M. The rheumatoid nodule. Arthritis Rheum 1984;27: 468–471.

    Article  Google Scholar 

  12. Campbell DA, Edwards NL. Multicentric reticulohistiocytosis: systemic macrophage disorder. Clin Rheumatol 1991;5:301–318.

    CAS  Google Scholar 

  13. Sokoloff L. The pathology of gout. Metabolism 1957;6: 230/243.

    CAS  PubMed  Google Scholar 

  14. Schumacher HR. Pathology of the synovial membrane in gout. Arthritis Rheum 1975;18(Suppl):771–782.

    Article  CAS  PubMed  Google Scholar 

  15. Palmer DG, Highton J, Hessian PA. Development of the gout tophus. A hypothesis. Am J Clin Pathol 1989;91: 190–195.

    CAS  Google Scholar 

  16. Moro F, Ogg CS, Simmonds HA, et al. Familial juvenile gouty nephropathy with renal urate hypoexcretion preceding renal disease. Clin Nephrol 1991;35:263–269.

    CAS  PubMed  Google Scholar 

  17. Burack DA, Griffith BP, Thompson ME, et al. Hyperuricemia and gout among heart transplant recipients receiving cyclosporine Am J Med 1992;92:141–146.

    Article  CAS  PubMed  Google Scholar 

  18. Howe S, Edwards NL. Controlling hyperuricemia and gout in cardiac transplant recipients. J Musculoskel Med 1995;12:15–24.

    Google Scholar 

  19. Lally EV, Ho G, Kaplan SR. The clinical spectrum of gouty arthritis in women. Arch Intern Med 1986;146: 2221–2225.

    Article  CAS  PubMed  Google Scholar 

  20. Puig JG, Michan AD, Jimenez ML, et al. Female gout: clinical spectrum and uric acid metabolism. Arch Intern Med 1991;151:726–732.

    Article  CAS  PubMed  Google Scholar 

  21. Reginato AJ, Schumacher HR, Allan DA, et al. Acute monoarthritis associated with lipid liquid crystals. Ann Rheum Dis 1985;44:537–543.

    Article  CAS  PubMed  Google Scholar 

  22. Baker DG, Schumacher HR Jr. Acute monoarthritis. N Engl J Med 1993;329:1013–1020.

    Article  CAS  PubMed  Google Scholar 

  23. Urano W, Yamanaka H, Tsytani H, et al. The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J Rheumatol 2002;29:1950–1953.

    CAS  PubMed  Google Scholar 

  24. Yu TF. Diversity of clinical features in gouty arthritis. Semin Arthritis Rheum 1984;13:360–368.

    Article  CAS  PubMed  Google Scholar 

  25. Puig JG, Fox IH. Ethanol-induced activations of adenine nucleotide turnover. Evidence for a role of acetate. J Clin Invest 1984;74:936–941.

    CAS  Google Scholar 

  26. Choi HK, Atkinson K, Karlson EW, et al. Alcohol intake and risk of incident gout in men and a prospective study. Lancet 2004;363:9417–9420.

    Article  Google Scholar 

  27. Popp JD, Edwards NL. New insights into gouty arthritis. Contemp Intern Med 1995;7:55–64.

    CAS  PubMed  Google Scholar 

  28. Mazzali M, Kanellis J, Han L, et al. Hyperuricemia induces a primary renal arteriopathy in rats by a blood pressure-independent mechanism. Am J Physiol Renal Physiol 2002;282:F991–F997.

    CAS  PubMed  Google Scholar 

  29. Feig DI, Johnson RJ. Hyperuricemia in childhood primary hypertension. Hypertension 2003;42:247–252.

    Article  CAS  PubMed  Google Scholar 

  30. Feig DI, Nakagawa T, Karumanchi SA, et al. Hypothesis: uric acid, nephron number, and the pathogenesis of essential hypertension. Kidney Int 2004;66:281–287.

    Article  CAS  PubMed  Google Scholar 

  31. Schlesinger N, Baker DG, Schumacher HR Jr. How well have diagnostic tests and therapies for gout been evaluated? Curr Opin Rheumatol 1999;11:441–445.

    Article  CAS  PubMed  Google Scholar 

  32. Choi HK, Mount DB, Reginato AM. Pathogenesis of Gout. Ann Intern Med 2005;143:499–516.

    CAS  PubMed  Google Scholar 

  33. Terkeltaub RA. Epidemiology, pathology, and pathogenesis. In: Klippel JH, ed. Primer on the rheumatic diseases, 12th ed. Atlanta: Arthritis Foundation; 2001:307–312.

    Google Scholar 

  34. Hochberg MC, Thomas J, Thomas DJ, et al. Racial differences in the incidence of gout. The role of hypertension. Arthritis Rheum 1995;38:628–632.

    Article  CAS  PubMed  Google Scholar 

  35. Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol 2002;29:2403–2406.

    PubMed  Google Scholar 

  36. Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med 1987;82:421–426.

    Article  CAS  PubMed  Google Scholar 

  37. Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004;51:321–325.

    Article  CAS  PubMed  Google Scholar 

  38. Choi HK, Atkinson K, Karlson EW, Willett WC, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004;350:1093–1103.

    Article  CAS  PubMed  Google Scholar 

  39. Emmerson BT. The management of gout. N Engl J Med 1996;334:445–451.

    Article  CAS  PubMed  Google Scholar 

  40. Choi HK, Atkinson K, Karlson EW, Willett WC, Curhan G. Alcohol intake and risk of incident gout in men—a prospective study. Lancet 2004;363:1277–1281.

    Article  PubMed  Google Scholar 

  41. Choi HK, Atkinson K, Karlson EW, Curhan G. Obesity, weight change, hypertension, diuretic use, and risk of gout in men—The Health Professionals Follow-Up Study. Arch Intern Med 2005;165:742–748.

    Article  PubMed  Google Scholar 

  42. Enomoto A, Kimura H, Chairoungdua A, et al. Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature 2002;417:447–452.

    CAS  PubMed  Google Scholar 

  43. Schumacher HR. Pathology of the synovial membrane in gout. Light and electron microscopic studies. Interpretation of crystals in electron micrographs. Arthritis Rheum 1975;18:771–782.

    Article  CAS  PubMed  Google Scholar 

  44. Pascual E, Batlle-Gualda E, Martinez A, Rosas J, Vela P. Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 1999;131:756–759.

    CAS  PubMed  Google Scholar 

  45. Liu-Bryan R, Terkeltaub R. Evil humors take their toll as innate immunity makes gouty joints TREM-ble. Arthritis Rheum 2006;54:383–386.

    Article  CAS  PubMed  Google Scholar 

  46. Cronstein BN, Molad Y, Reibman J, Balakhane E, Levin RI, Weissmann G. Colchicine alters the quantitative and qualitative display of selectins on endothelial cells and neutrophils. J Clin Invest 1995;96:994–1002.

    Article  CAS  PubMed  Google Scholar 

  47. Terkeltaub R, Baird S, Sears P, Santiago R, Boisvert W. The murine homolog of the interleukin-8 receptor CXCR-2 is essential for the occurrence of neutrophilic inflammation in the air pouch model of acute urate crystal-induced gouty synovitis. Arthritis Rheum 1998; 41:900–909.

    Article  CAS  PubMed  Google Scholar 

  48. Liu R, Liote F, Rose DM, Merz D, Terkeltaub R. Proline-rich tyrosine kinase 2 and Src kinase signaling transduce monosodium urate crystal-induced nitric oxide production and matrix metalloproteinase 3 ex- pression in chondrocytes. Arthritis Rheum 2004;50: 247–258.

    Article  CAS  PubMed  Google Scholar 

  49. Terkeltaub RA. Clinical practice. Gout. N Engl J Med 2003;349:1647–1655.

    Article  CAS  PubMed  Google Scholar 

  50. Rubin BR, Burton R, Navarra S, et al. Efficacy and safety profile of treatment with etoricoxib 120 mg once daily compared with indomethacin 50 mg three times daily in acute gout: a randomized controlled trial. Arthritis Rheum 2004;50:598–606.

    Article  CAS  PubMed  Google Scholar 

  51. Cronstein BN, Terkeltaub R. The inflammatory process of gout and its treatment. Arthritis Res Ther 2006;8(suppl 1):S3.

    Article  PubMed  Google Scholar 

  52. Martinon F, Petrilli V, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 2006;440:237–241.

    Article  CAS  PubMed  Google Scholar 

  53. Dessein PH, Shipton EA, Stanwix AE, Joffe BI, Ramokgadi J. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59:539–543.

    Article  CAS  PubMed  Google Scholar 

  54. Becker MA, Schumacher HR Jr, Wortmann RL, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005;353:2450–2461.

    Article  CAS  PubMed  Google Scholar 

  55. Hung SI, Chung WH, Liou LB, et al. HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Proc Natl Acad Sci U S A. 2005;102:4134–4139.

    Article  CAS  PubMed  Google Scholar 

  56. Kanellis J, Feig DI, Johnson RJ. Does asymptomatic hyperuricaemia contribute to the development of renal and cardiovascular disease? An old controversy renewed. Nephrology 2004;9:394–399.

    Google Scholar 

  57. Okamoto K, Eger BT, Nishino T, Kondo S, Pai EF, Nishino T. An extremely potent inhibitor of xanthine oxidoreductase. Crystal structure of the enzyme-inhibitor complex and mechanism of inhibition. J Biol Chem 2003;278:1848–1855.

    Article  CAS  PubMed  Google Scholar 

  58. Ganson NJ, Kelly SJ, Scarlett E, Sundy JS, Hershfield MS. Control of hyperuricemia in subjects with refractory gout, and induction of antibody against poly(ethylene) glycol (PEG), in a phase I trial of subcutaneous PEGylated urate oxidase. Arthritis Res Ther 2005;8:R12.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, University of Florida, Gainesville, FL, USA

    N. Lawrence Edwards MD (Professor and Vice Chairman)

Authors
  1. N. Lawrence Edwards MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Arthritis Foundation, Atlanta, GA, USA

    John H. Klippel MD (President and CEO) (President and CEO)

  2. Massachusetts General Hospital, Boston, MA, USA

    John H. Stone MD, MPH (Associate Physician, Deputy Editor for Rheumatology) (Associate Physician, Deputy Editor for Rheumatology)

  3. Division of Rheumatology & Women’s Health, University of Kentucky, Lexington, KY, USA

    Leslie J. Crofford MD (Gloria W. Singletary Professor of Internal Medicine, Chief) (Gloria W. Singletary Professor of Internal Medicine, Chief)

  4. Arthritis Foundation, Atlanta, GA, USA

    Patience H. White MD, MA (Chief Public Health Officer) (Chief Public Health Officer)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Edwards, N.L. (2008). Gout. In: Klippel, J.H., Stone, J.H., Crofford, L.J., White, P.H. (eds) Primer on the Rheumatic Diseases. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68566-3_12

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-68566-3_12

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-35664-8

  • Online ISBN: 978-0-387-68566-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation