Current Rheumatology Reviews - Volume 7, Issue 2, 2011

This Hot Topic issue focuses on gout, for the first time in Current Rheumatology Reviews. The pathogenesis of gout encompasses many pathways, all of relevance for prevention and treatment, all with genetic and environmental risk factors, including but not limited to, production of urate in the blood, renal urate transport, monosodium urate crystal formation, activity of the inflammasome, bone erosion and the relationship with Read More

The diagnosis of gout is usually straightforward and should normally rely upon the identification of monosodium urate crystals in synovial fluid. EULAR have recently developed consensus recommendations regarding the diagnosis of gout. Where examination of synovial fluid is not possible or impractical, the best approach differs depending upon the context: in clinical research, classification criteria are necessary whereas in cl Read More

Gout is an ancient disease with a prevalence that has increased dramatically worldwide over recent years. This paper briefly reviews the recent literature on the frequency of gout and geographic variation in contemporary populations and attempts to provide a synthesis of reported cases of gout in the past. The palaeopathological evidence of gout in the Asia Pacific region is focussed on and the biocultural context of food an Read More

Gout results from hyperuricaemia. The most important cause of hyperuricaemia is reduced excretion of uric acid in the urine. Genome-wide association scans for genes regulating serum urate concentrations have identified two major regulators - the renal urate transporters SLC2A9 and ABCG2. The risk variants at each gene approximately double the risk for gout in people of Caucasian ancestry, with the urate and fructo Read More

Urate (uric acid) is the final product of purine metabolism, and its antioxidant capacity has drawn attention recently for its protective role against oxidative stress. However, hyperuricemia has a known association with onset of illnesses such as gout and cardiovascular diseases. Renal urate transport mechanisms are known to be major determinants of serum urate levels, but the molecular mechanisms involved have not yet Read More

Gout is one of the most common and painful forms of arthritis in humans with a growing incidence and prevalence over the last decades. Recent studies into the pathophysiology of acute gout have revealed that MSU (monosodium urate), the crystalline form of uric acid, is recognized by immune cells as a danger signal and can initiate an inflammatory response. This response is orchestrated by the intracellular pattern-re Read More

Untreated or inadequately treated gout results in recurrent acute gouty attacks (one of the most painful forms of acute arthritis), progressive joint damage, formation of tophi, loss of function and disability. The management of gout comprises several key areas. Firstly an accurate diagnosis is required, secondly, long-term urate lowering is required to dissolve monosodium urate crystals and prevent recurrent attacks and subse Read More

Gout is an inflammatory arthritis caused by deposition of monosodium urate (MSU) monohydrate crystals within the joint. Bone erosion is a frequent manifestation of chronic tophaceous gout, and leads to joint damage and deformity, with subsequent disability. This review summarises current understanding of bone remodelling, bone erosion in other erosive arthropathies and related conditions, and bone erosion in chr Read More

An elevated uric acid is common in subjects with insulin resistance and obesity, and is in effect part of the metabolic syndrome complex. In this paper we review evidence for a potential causal role of uric acid in the metabolic syndrome. While some studies suggest that uric acid may simply be a consequence of the presence of oxidative stress or hyperinsulinemia present in subjects with metabolic syndrome, there is increasi Read More

Although there has been a steady increase in the number of literature reviews on the epidemiology, pathophysiology, diagnosis and treatment of gout there has not been a similar output on the societal and cultural aspects, following the pivotal work of Porter and Rousseau, Gout: The Patrician Malady, which chronicled the socio-political aspects of gout from antiquity to the 1930s. Several excellent reviews which do discuss thes Read More