The anatomical pathology of gout: a systematic literature review

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. Electronic supplementary material The online version of this article (10.1186/s12891-019-2519-y) contains supplementary material, which is available to authorized users.

A Patient with Complex Gout with an Autoinflammatory Syndrome and a Sternoclavicular Joint Arthritis as Presenting Symptoms

“…A gouty arthritis with a sternoclavicular localization is a very rare finding (in the literature, only three similar cases are proved [6]). Classically, imagining a classic case of gout, we thought more frequently to the metatarsophalangeal joint (podagra), to proximal and distal interphalangeal, to elbow and knee [1,5,7] Our patient had an intermediate probability of having gout (7.5 points) [8]. In this case, the gold standard for the diagnosis of gout remains arthrocentesis with the detection of uric acid crystals [8].…”

“…e patient's anamnesis is for a chronic gouty arthritis characterized by the presence of tophi and frequent arthritis; the first gouty attack was in 2011 on the ankles treated with steroids. In 2014, he has undergone surgical operation with the removal of tophaceus masses [1] at the sixth compartment of the right hand because of severe pain and losing range of motion in the affected joint.…”

“…We have also excluded osteoarthritis because of the absence of the classical radiological signs (narrowing of joint space, Case Reports in Rheumatology osteophytes, subchondral bony sclerosis, and subchondral cysts) [4,5]. erefore, we continued with a functional ultrasound scan to the knee that showed synovitis with joint effusion and the characteristic double contour that means the presence of deposits of urate at the femoral condyles cartilage level (Figure 3) [1]. e synovial fluid, drawn at the knee level, confirmed this hypothesis given the presence of uric acid crystals.…”

“…We performed a CT with the DUAL ENERGY (DECT) method, which confirmed the suspicion of gout-originated arthropathy at the sternoclavicular joints, explaining the patient's chest symptoms. Specifically, we show the 3D reconstruction of the dual energy CT of the sternoclavicular joints and the foot (Figures 4 and 5) [1]. e uric acid deposits appear in green, while the bone calcium appears in purple.…”

“…Our patient has a systemic disease with destructive deforming arthritis. Indeed, it has some tophaceous lesions ( Figure 6) [1].…”