Directions and prospects for future research on gout

✍ Scribed by J. Edwin Seegmiller

• Publisher: John Wiley and Sons
• Year: 1975
• Tongue: English
• Weight: 492 KB
• Volume: 18
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780180736

✦ Synopsis

Knowledge of the causes and mechanism of development of gouty arthritis has been greatly expanded within the past 15 years (12). Nevertheless many gaps still exist. T h e molecular basis of the ability of the crystal of monosodium urate (3,4), but not that of cystine (5,6), to produce a disruption of the lysosomal membrane needs more detailed investigation. Additional information is still needed on the precise role of uric acid and its salt in the genesis of renal dysfunction in gout. T h e presence of monosodium urate crystals in the renal parenchyma of at least some of the patients with gout (7) raises the possibility that part of the pathologic process leading to renal dysfunction involves an acute intermittent inflammatory response to monosodium urate crystals similar to that observed in peripheral joints. Such an acute gouty nephropathy as part of the pathology of gout has not heretofore been recognized either c h ically or pathologically (1,Z).

I n order to assess this possibility clinicians should be alert to the possibility of acute gouty nephropathy in their patients with known gout. Pain or tenderness in the renal area in the absence of infection or renal calculi should prompt a urine analysis. T h e presence of transient proteinuria or a sterile pyruria, perhaps with systemic symptoms of malaise,