What is the pathogenesis of gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Gout can be considered a disorder of metabolism that allows uric acid or urate to accumulate in blood and tissues. When tissues become supersaturated, the urate salts precipitate, forming monosodium urate crystals. Deposition of these crystals is most commonly reported in synovium, bone, skin, cartilage, tendon, ligament, and kidney, but involvement of a range of other musculoskeletal and non-musculoskeletal tissues also occurs. [7] In addition, the crystals also are less soluble under acid conditions and at low temperatures, such as occur in cool, peripheral joints (eg, the metatarsophalangeal joint of the big toe).

Urate initially precipitates in the form of needlelike crystals. The light-retarding (phase-shifting) characteristics of urate crystals allow them to be recognized by polarizing microscopy (see the image below).

Gout. Needles of urate crystals seen on polarizing microscopy.

Gout. Needles of urate crystals seen on polarizing Gout. Needles of urate crystals seen on polarizing microscopy.

Many conditions and drugs have been associated with an increase in plasma (and subsequent synovial) urate levels, particularly metabolic syndrome. [8] A genetic predisposition for hyperuricemia exists; except in rare genetic disorders, however, the development of gout in hyperuricemic individuals appears to be mediated by environmental factors. [9, 10]

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