Gout Inflammation Associated with Metabolic Issues

HOUSTON — Comorbidity factors including hyperlipidemia, hypertension and diabetes are significantly associated with the inflammatory cells in gout tissues, according to a study from the Michael E. DeBakey VA Medical Center and other medical institutions in Houston.

According to background in the article, published in the Open Rheumatology Journal, the key pathological finding of gout is the deposition of monosodium urate monohydrate (MSU) crystals with inflammatory infiltrate in the tissue. Despite reports of in vitro analysis of inflammatory mechanism and comorbidities in gout, the associations of immune response cells and comorbidities of gout have not been well documented, according to the study authors.1

For the research, investigators surgically resected or biopsied tissues from 48 patients diagnosed with gout. Cell count was performed on Hemotoxylin and Eosin stained sections for macrophages, plasma cells, neutrophils and on immunostained slides for T and B lymphocytes.

Researchers found hyperlipidemia, hypertension and diabetes mellitus in 70.8%, 87.5% and 37.5% of patients, respectively.

Of the patients, 35.6% said they had smoking history and 37.8% admitted alcohol intake. Mean serum uric acid level was 8.5 mg/dl, while the average body mass index was 30.1 kg/m2.

H&E stained tissue sections demonstrated the crystalline deposits rimmed by palisading multinucleated giant cells, macrophages, neutrophils, plasma cells, T and B cells. Significant correlations between the clinical features and tissue inflammatory cells were observed in hyperlipidemia with number of T cells (p = 0.0363), hypertension with number of T cells and B cells (p = 0.0138 and 0.0033, respectively), diabetes mellitus with macrophages (p = 0.0016), and uric acid level with giant cells (p = 0.0088), according to the report.

“Understanding the inflammatory nature of uric acid crystals is essential to gain insight into the pathogenic mechanism of gout,” according to the study authors. “There are emerging lines of evidence of immunologic responses contributing to the mechanisms and processes involved in MSU-mediated adjuvanticity and inflammation in vitro experimental models in the last decades. However, only few studies of in vivo tissue examination for the cellular characterizations were published.”

1 Lai S, Zhou X. Inflammatory cells in tissues of gout patients and their correlations with comorbidities. Open Rheumatol J. 2013 Apr 19;7:26-31. doi:10.2174/1874312901307010026. Print 2013. PubMed PMID: 23802027; PubMed Central PMCID: PMC3681035.

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