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Review
. 2024 Mar 1;36(1):1-11.
doi: 10.5371/hp.2024.36.1.1.

Pathophysiology and Treatment of Gout Arthritis; including Gout Arthritis of Hip Joint: A Literature Review

Yonghan Cha  1 , Jongwon Lee  1 , Wonsik Choy  1 , Jae Sun Lee  2   3 , Hyun Hee Lee  4 , Dong-Sik Chae  4
Affiliations
Review

Pathophysiology and Treatment of Gout Arthritis; including Gout Arthritis of Hip Joint: A Literature Review

Yonghan Cha et al. Hip Pelvis. .

Abstract

Gout is triggered by the accumulation of uric acid in the body, leading to hyperuricemia. Genetic, metabolic, and environmental factors can influence this condition. Excessive uric acid buildup results in the formation of monosodium urate (MSU) crystals, which precipitate in specific areas of the body, including the joints, where they can cause symptoms of gout. While the acute and chronic symptoms of gout have been well-documented, diagnosis of gout affecting the hip joint poses significant challenges. The global incidence of gout, the most prevalent form of inflammatory arthritis, is on the rise. Evaluation of the clinical signs, laboratory results, and imaging results is generally required for diagnosis of gout in cases where MSU crystals have not been detected. Hyperuricemia is considered a primary cause of arthritis symptoms, and comprehensive guidelines for treatment are available. Therefore, the choice of medication is straightforward, and moderate effectiveness of treatment has been demonstrated. Gout is a chronic disease, requiring lifelong uric acid-lowering medications, thus application of a treatment strategy based on the target blood uric acid concentration is necessary. Consequently, cases of gout will likely be observed more frequently by hip surgeons in clinical scenarios in the future. The objective of this review is to provide an overview of the pathophysiology of gout and subsequently examine recent advances in diagnostic methods and therapeutic agents based on an understanding of its underlying mechanisms. In addition, literature on gout-related issues affecting the hip joint, providing a useful reference for hip surgeons is examined.

Keywords: Diagnosis; Gout; Hip joint; Total hip arthroplasty; Treatment.

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Conflict of interest statement

CONFLICT OF INTEREST

No other potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
The molecular mechanisms in acute and chronic gout arthritis. (A) The key pathophysiology of acute gout is necroinflammation. (1) Monosodium urate (MSU) crystals elicit direct cytotoxic effects on epithelial cells by activating necroptosis. (2) Epithelial cell death releases damage-associated molecular patterns (DAMPs) and alarmins. (3) Mononuclear phagocytes take up MSU crystals, a process activating the NLR family pyrin domain-containing 3 (NLRP3)/interleukin (IL)-1β inflammasome and inducing local secretion of mature IL-1β as well as IL-1α. (4) Both forms of IL-1 activate the IL-1R on parenchymal and immune cells to secrete numerous proinflammatory mediators. (5) Among these mediators, several promote the rapid recruitment of neutrophils. (6) Neutrophils encounter MSU crystals, undergo necroptosis and neutrophil extracellular trap (NET) formation. (7) Necrotic neutrophils and NETs release various proinflammatory mediators, such as lytic proteases and cytotoxic histones, that further contribute to the crescendo of the auto-amplification loop of necroinflammation (vicious cycle). (B) Granuloma formation with tophus masses at the center, surrounded by giant cells and epitheloid cell layers can lead to bony lesions, soft tissue damage, and tissue remodeling.
Fig. 2
Fig. 2
In the longitudinal ultrasound scan of the hip joint it is possible to observe the formation of a double contour (arrowheads) on the overlying hyaline cartilage of the femoral head. This double contour is caused by the intraarticular aggregation of monosodium urate crystal deposits.
See this image and copyright information in PMC

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Grants and funding

FUNDING This research was supported by “Regional Innovation Strategy (RIS)” through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (MOE) (2021RIS-001).

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