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. 2011 Dec;25(12):4073-8.
doi: 10.1096/fj.11-1201ufm.

Inflammatory gout: observations over a half-century

Stephen E Malawista  1 , Anne Chevance de Boisfleury, Paul H Naccache
Affiliations

Inflammatory gout: observations over a half-century

Stephen E Malawista et al. FASEB J. 2011 Dec.

Abstract

This is a discussion of acute gouty arthritis, seen for over 50 years of engagement. It addresses the evolution of our current understanding of the interaction between urate crystals and key cellular components of the gouty inflammatory paroxysm, with new material on pathogenesis.

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Figures

None
Bunbury's Dream: “Funny, the faster he makes them go, the worse my gout gets.” Color image from Bunbury, Henry William, 1750–1810: Origin of the Gout.
Figure 1.
Figure 1.
Neutrophils in serum buffer are attracted to urate crystals but often do not ingest them (flirtation). For over 9 min, a neutrophil approached and contacted the crystal shown and then left it but returned (A) and enveloped it over 1-min time (B and C), only to retreat once more (at 5 o'clock; D), as another neutrophil approached (from 11 o'clock) and briefly contacted the crystal. Over the next 7 min, the original neutrophil continued to circle. See Supplemental Video.
Figure 2.
Figure 2.
Some contributors to crystal uptake by neutrophils in vitro. Uptake is more efficient with (A) serum, (B) activable complement, (C) monocyte/crystal-conditioned media, and (D and E) the monocyte products IL-1β and GM-CSF.
Figure 3.
Figure 3.
Monocyte with crystals attracts neutrophils (commitment). (A) Monocyte (m) is ingesting crystals. (B) +12 min: neutrophils have been arriving, including an eosinophil (e). Some have crystals attached to their tails but not ingested. They swarm about in close contact with the monocyte. (C) +8 more min: the monocyte, still attractive and intact, appears to have ingested the (black and white) crystals. See Supplemental Video.
Figure 4.
Figure 4.
Monocyte with crystals continues to attract neutrophils postmortem. (A) Two monocytes; one with crystals. (B) + 2 min: cell membrane of the latter swells and detaches as large vesicles (the cell is dying), but (C) 22 min later, the cell body continues to attract neutrophils. The monocyte without crystals moves off to the lower right, ignored by the neutrophils. See Supplemental Video.
See this image and copyright information in PMC

References

    1. Garrod A. (1876) A Treatise on Gout and Rheumatic Gout (Rheumatoid Arthritis), Longmans, Green & Co., London
    1. Ropes M., Bauer W. (1953) Synovial Fluid Changes in Joint Disease, Harvard University Press, Cambridge, MA, USA, 92–93
    1. McCarty D. J., Hollander J. L. (1961) Identification of urate crystals in gouty synovial fluid. Ann. Intern. Med. 54, 452–460 - PubMed
    1. Seegmiller J. E., Howell R. R., Malawista S. E. (1962) The inflammatory reaction to sodium urate: its possible relationship to the genesis of acute gouty arthritis. JAMA 180, 469
    1. McCarty D. J. (1962) Phagocytosis of urate crystals in gouty synovial fluid. Am. J. Med. Sci. 243, 288 - PubMed

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