Gout is a chronic and progressive disease, if left untreated or treated inadequately
A new research paper has published previously unknown data that may contribute to our understanding of gout as a crystal deposition disease.
Emeritus Professor of Medicine, Elisio Pascual, at the Miguel Hernández University (UMH) in Elche and former head of the Rheumatology Unit at Alicante University Hospital, has published the study in the Nature Reviews of Rheumatology journal. The study lays the foundations for understanding how and where the formation of monosodium urate crystals occurs, something which has received little attention in the scientific community.
Gout is a type of arthritis, often found in various foot joints. It is caused by a build-up of high levels of uric acid in the blood, which crystallises and deposits in the form on monosodium urate in and around the joints, tendons and surrounding tissue. These crystals can cause the joint to become inflamed and painful.
Until now, little was known about the mechanism by which the crystals form or why is occurs at these specific sites. This is because the process typically used to study the tissue caused the crystals to dissolve, meaning that they were absent from samples which were then sent off to the pathology lab for analysis.
However, by using another method – surgical biopsy – the crystals are well-preserved and can be studied to understand the mechanisms behind their formation. Together with recent data on crystal deposit sites obtained using ultrasonography, scientists now have a more complete overview of the crystal formation process.
The study showed that crystals form at the cartilage surface, as well as inside tendons and ligaments. They form on the collagen fibres (supporting fibres in organs and tissues) found in the synovial fluid around gouty joints, which are complementary in structure. Also complementary in structure are existing crystal deposits, which is what makes gout a progressive disease.
These findings should change our perception of gout. Often thought of as an episodic disease, only present during attacks of gout arthritis, the study reveals that it is in fact the consequence of continual crystal deposition, which will only increase over time if left untreated.
It is estimated that between one and two in every 100 people in the UK are affected by gout.
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