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Why Doesn't Everyone with Hyperuricemia Develop Gout?

November 17 2014 4:18 AM ET via RheumReports RheumReports

At urate concentations >6.8 mg/dL (408 umoL/L), monosodium urate (MSU) crystals form at physiologic temperatures and pH. However, hyperuricemia is required but not sufficient for the development of gout. Not all individuals, even with very high urate levels, will develop gout. Why do some individuals with hyperuricemia not develop clinically apparent gout? The factors purported to be important include the site of deposition, the amount of urate deposited, and the inflammatory response.

In a study presented at ACR 2014 (Abstract #828), dual-energy CT scans of the feet were compared in 25 patients with asymptomatic hyperuricemia (>9 mg/dL - 540 umoL/L) and 33 patients with crystal proven gout. Control groups included 10  asymptomatic patients with normal uric acid levels (negative controls)20 patients with crystal proven tophaceous gout (positive controls).

Patients with gout were much more likely to have uric acid deposition (82% vs. 24%). The volume of deposition of uric acid was also much greater in patients with gout. Regardless of whether the gout was early (<3 years) or late, similar rates of urate deposition were observed. 

The conclusion is urate deposition occurs more frequently and at higher volumes in patients with symptomatic gout. The question remains, why do some patients deposit urate while others don't?


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About the Author

Dr. Andy Thompson
Dr. Andy Thompson

Dr. Andy Thompson is an Associate Professor at Western University and founder of Rheuminfo.com, Rheumtalks.com, and RheumReports.com.

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