Gout an autoinflammatory disease

Gout is one of the oldest known diseases. The disease was known to the Egyptians as early as 2640 B.C., and the ancient Greek physician Hippocrates called it "foot gout". It was once considered an "aristocratic disease" of the wealthy who could afford rich food and drink in abundance. Today we know that gout can affect anyone – it has become a common disease of the 21st century. become one of the most common forms of gout in the twentieth century.

Gout is a chronic inflammatory disease, in the course of which acute attacks cause very painful inflammation
Joint inflammation (arthritis) trigger. It is now known that inflammation in the acute attack of gouty arthritis is mediated by the pro-inflammatory messenger IL-1β [1]. Therefore, gout is now also classified as an autoinflammatory disease.

Gout occurs when uric acid levels in the blood are too high. This is called hyperuricemia. Normally, uric acid is dissolved in the blood, passes through the kidneys and is excreted in the urine. Uric acid levels in the blood can be too high if the body makes too much uric acid or the kidneys excrete too little. Uric acid levels are measured by determining the amount of urate (a form of uric acid) in the blood (serum urate level). High uric acid levels increase the risk of uric acid (MNU) crystals being deposited in joints, in ties around joints, and elsewhere in the body. This is called tophi or gout tophi. These deposited crystals can then cause the inflammation and Gout attacks cause.

Incidence of gout

In industrialized countries, gout is common, especially in older men. In Europe, the number of gout patients ranges from 1% of the population in France, Germany, and the United Kingdom to nearly 5% in Greece [4, 5, 7]. Gout occurs most often in men over the age of 40. In women after menopause on. The number of gout patients has been increasing for several decades.

Incidence of gout in different regions [2-12]

Complaints of gout

For Acute attacks of gout very quickly, in addition to the inflammation (redness, swelling), also cause unbearable pain. After 8 to 12 hours, they reach their highest intensity. The gout attack is considered one of the most painful attacks a person can experience. It often occurs in the legs or feet and frequently affects a single joint, especially the large joint of the big toe.

Systemic signs (affecting the entire body), such as mild fever, chills and malaise, often accompany the disease. If untreated, the most severe phase of the first attack usually lasts 3 to 4 days, with the pain gradually subsiding over the following 3 to 4 days. This pain disappears by itself. Inflammation is typical of gout.


Long-term If left untreated or inadequately treated, up to three-quarters of gout sufferers will develop advanced gout. Severe joint damage and bone loss may then occur. This phase is also known as chronic tophus gout.

The affected joints are constantly stiff, swollen and painful, and acute attacks still occur. The arm and wrist joints are also more affected during this phase. Tophi may not be visible at first. In most patients, however, visible tophi develop over time. These tophi are found almost all over the body.

Gout an autoinflammatory disease

Long-term course in inadequately treated gouty arthritis (schematic diagram, mod. according to [16])

In addition, gout patients may experience kidney damage and the formation of kidney stones, which are composed of uric acid.

Causes of gouty arthritis

As in all autoinflammatory diseases, there is activation of the innate immune system. In the setting of an acute gout attack Uric acid crystals (MNU crystals) are the cause of this activation: The crystals preferentially accumulate in joints. They are recognized as foreign by the immune system. Absorbed within the joints by the scavenger cells of the immune system (macrophages). In macrophages, they trigger the formation and release of the inflammatory messenger IL-1β [13]. The affected joints become inflamed.

Uric acid crystals promote the release of IL-1 in joints (mod. according to [17])

Booth: 23.05.2017

Author: Dr. med. Susanne Rodel, Dr. rer. nat. Regina Flach

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