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. 2019 Apr 1;20(1):140.
doi: 10.1186/s12891-019-2519-y.

The anatomical pathology of gout: a systematic literature review

Patapong Towiwat  1   2 , Ashika Chhana  3 , Nicola Dalbeth  3
Affiliations

The anatomical pathology of gout: a systematic literature review

Patapong Towiwat et al. BMC Musculoskelet Disord. .

Abstract

Background: The aim of this systematic literature review was to comprehensively describe the anatomical pathology of tissues affected by gout.

Methods: We searched PubMed, The Cochrane Library, Excerpta Medica Database (EMBASE), and Web of Science Core Collection for all English language articles published before March 2018. Articles were included if they described the microscopic or macroscopic appearances of gout in human tissue.

Results: Four hundred and seventeen articles met inclusion criteria and were included in the review. Articles describing the anatomical pathology of gout in musculoskeletal structures, including bone, tendon and ligaments, synovium and cartilage, were most common. Articles describing skin and kidney pathology in gout were also common, with pathology in other sites such as visceral organs less common. At all sites, monosodium urate crystal deposition was reported, and the tophus was also described within many different tissues. During a gout flare, diffuse acute neutrophilic synovial inflammation was evident. The tophus was described as an organised chronic giant cell granulomatous structure consisting of monosodium urate crystals, innate and adaptive immune cells, and fibrovascular tissue.

Conclusions: Consistent with the clinical presentation of gout, most studies describing the anatomical pathology of gout report involvement of musculoskeletal structures, with monosodium urate crystal deposition and tophus the most common lesions described. This review details the anatomical pathology features of gout at affected sites.

Keywords: Gout; Histology; Pathology; Synovium; Tophus.

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Conflict of interest statement

Ethics approval and consent to participate

Human sample collection was approved by the Northern Regional ethics committee and all patients provided written informed consent. Collection and use of human cadaveric tissue was in accordance with the New Zealand Human Tissue Act 2008.

Consent for publication

Not applicable.

Competing interests

Dr. Dalbeth discloses the following: research grant funding from Amgen and AstraZeneca, speaker fees from Pfizer, Janssen, Horizon and Abbvie, consulting fees from Horizon and Kowa, outside the submitted work. The other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Summary of literature search results
Fig. 2
Fig. 2
Photograph showing MSU crystal deposition, tophus and joint damage at the macroscopic level (sagittal plane) in the left first metatarsophalangeal joint from a cadaveric donor with tophaceous gout. Bone erosion and cartilage damage adjacent to MSU crystal deposition and tophus can be seen. Fibrous septae are also evident between deposits of MSU crystals within the tophus
Fig. 3
Fig. 3
Collections of birefringent MSU crystals within an olecranon bursa tophus. Tissue section is unstained and viewed using polarizing light microscopy with a red compensator
Fig. 4
Fig. 4
Tophus associated with structural damage in a right little finger distal interphalangeal joint from a cadaveric donor with microscopically proven gout. The joint architecture has been lost, with tophus and significant bone erosion present. Tissue is stained with haematoxylin and eosin and viewed by light microscopy
Fig. 5
Fig. 5
Chronic synovial inflammation with synovial microtophi in a right ring finger proximal interphalangeal joint from a cadaveric donor with microscopically proven gout. Tissue is stained with haematoxylin and eosin and viewed by light microscopy
Fig. 6
Fig. 6
Immunohistochemistry analysis of a knee from a patient with gout stained with tartrate-resistant acid phosphatase (TRAP) demonstrating the presence of multi-nucleated osteoclasts (stained brown) at the bone–tophus interface
Fig. 7
Fig. 7
Toluidine blue stained tissue from left first metatarsophalangeal joint of a cadaveric donor with microscopically proven gout, showing MSU crystals deposited on the cartilage surface. Viewed using polarising light microscopy with a red compensator
See this image and copyright information in PMC

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