The morphological changes in joints tissues in cases of primary tophus gout
Keywords:chronic gout, monosodium urate, articular capsule, inflammation, tophi, uricemia
Gout is a chronic disease which is accompanied by a primary violation of the uric acid (purine) metabolism, increased value of uric acid (hyperuricemia) in blood and urates’ deposition in tissues (crystals of the sodium salt of the uric acid). The incidence of gout is increasing in recent years. Men suffer from this pathology in the USA in 0.84% cases, in the Western Europe from 0.1 to 2 % cases, and in persons over 55 years old is about 6 % ones. Prevalence of gouty arthritis in Ukraine is 64.7 per 100 000 of population.
Objective: to clarify the morphological changes in the tissues joints and periarticular structures in patients with primary tophaceous gout course.
Methods: morphological study of the surgical specimens taken during surgery for removal of gouty tophi and correction of deformations performed in 32 patients with chronic gout (31 men and 1 woman), aged from 39 to 78 years (mean age - 56,1 ± 3,5 years).
Results: during the first 1-3 years of tophi form rarely. Just in case of severe pathological process their formation directly depends on value of uremia. With increasing of the disease structural and functional organization changes of the joint capsule progressed. Necrotic and destructive processes predominated. In severe cases of the clinical course of gout accompanied with high content of uric acid in blood serum, frequent (4-5 times a year) and continuous attacks of gout, which intakes 3 to 4 or more joints, bright distinct degenerative and necrotic changes not just in the joint capsule but also in paraarticular tissues, primarily joint cartilage and subchondral bone came out. They firstly characterized with activation of endochondral ossification or dystrophic and necrotic lesions of the articular cartilage and subchondral bone.
Conclusions: gouty arthritis is one of the variants of chronic inflammation, which is determined by the deposition of urates of the uric acid into the joint capsule and characterized by active fibroblastic proliferation of cellular elements with the formation of fibrous connective tissue on early stages, and in cases of severe course it characterized by actively progressing degenerative and destructive lesions of all joint tissues leading to disability. The basis of the inflammatory cell infiltrate is combination of macrophages, lymphocytes, cellular elements of the connective tissue (fibroblasts) and giant cell formation. Defined by us pathomorphologic vicissitude of pathologic changes in the joint tissues allows to clarify the therapeutic approach to tophaceous gout. Direct dependence of the severity of pathological changes in the joint tissues on the severity of the clinical course of gout requires active prevention and reduction of the frequency of exacerbations of the pathologic process.
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