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Revisiting the pathogenesis of podagra: why does gout target the foot?

Roddy E - J Foot Ankle Res (2011)

Bottom Line: This invited paper provides a summary of a keynote lecture delivered at the 2011 Australasian Podiatry Conference.It displays a striking predilection to affect the first metatarsophalangeal joint as well as joints within the mid-foot and ankle.The proclivity of gout for the first metatarsophalangeal joint is likely to be multi-factorial in origin, arising from the unique combination of the susceptibility of the joint to osteoarthritis and other determinants of urate solubility and crystal nucleation such as temperature and minor physical trauma which are particularly relevant to the foot.

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Affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK. e.roddy@cphc.keele.ac.uk.

ABSTRACT
This invited paper provides a summary of a keynote lecture delivered at the 2011 Australasian Podiatry Conference. Gout is the most prevalent inflammatory arthropathy. It displays a striking predilection to affect the first metatarsophalangeal joint as well as joints within the mid-foot and ankle. A number of factors are known to reduce urate solubility and enhance nucleation of monosodium urate crystals including decreased temperature, lower pH and physical shock, all of which may be particularly relevant to crystal deposition in the foot. An association has also been proposed between monosodium urate crystal deposition and osteoarthritis, which also targets the first metatarsophalangeal joint. Cadaveric, clinical and radiographic studies indicate that monosodium urate crystals more readily deposit in osteoarthritic cartilage. Transient intra-articular hyperuricaemia and precipitation of monosodium urate crystals is thought to follow overnight resolution of synovial effusion within the osteoarthritic first metatarsophalangeal joint. The proclivity of gout for the first metatarsophalangeal joint is likely to be multi-factorial in origin, arising from the unique combination of the susceptibility of the joint to osteoarthritis and other determinants of urate solubility and crystal nucleation such as temperature and minor physical trauma which are particularly relevant to the foot.

No MeSH data available.


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Processes enhancing MSU crystal formation and deposition at the first MTPJ.
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Figure 3: Processes enhancing MSU crystal formation and deposition at the first MTPJ.

Mentions: Gout is one of the best understood inflammatory arthropathies. Clinical features can be easily understood and interpreted in the context of a clearly elucidated pathogenetic process. Specific risk factors such as genetics, dietary factors, co-morbidity and its treatment lead to hyperuricaemia and subsequently MSU crystal formation occurs [16,17]. Crystals are then shed into the joint and activate the inflammatory cascade via the NALP3 inflammasome [18,19]. Hence, any explanation of why gout targets the foot must link these pathological processes to the specific anatomical, functional, and disease characteristics of the foot (Figure 3).


Revisiting the pathogenesis of podagra: why does gout target the foot?

Roddy E - J Foot Ankle Res (2011)

Processes enhancing MSU crystal formation and deposition at the first MTPJ.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117776&req=5

Figure 3: Processes enhancing MSU crystal formation and deposition at the first MTPJ.
Mentions: Gout is one of the best understood inflammatory arthropathies. Clinical features can be easily understood and interpreted in the context of a clearly elucidated pathogenetic process. Specific risk factors such as genetics, dietary factors, co-morbidity and its treatment lead to hyperuricaemia and subsequently MSU crystal formation occurs [16,17]. Crystals are then shed into the joint and activate the inflammatory cascade via the NALP3 inflammasome [18,19]. Hence, any explanation of why gout targets the foot must link these pathological processes to the specific anatomical, functional, and disease characteristics of the foot (Figure 3).

Bottom Line: This invited paper provides a summary of a keynote lecture delivered at the 2011 Australasian Podiatry Conference.It displays a striking predilection to affect the first metatarsophalangeal joint as well as joints within the mid-foot and ankle.The proclivity of gout for the first metatarsophalangeal joint is likely to be multi-factorial in origin, arising from the unique combination of the susceptibility of the joint to osteoarthritis and other determinants of urate solubility and crystal nucleation such as temperature and minor physical trauma which are particularly relevant to the foot.

View Article: PubMed Central - HTML - PubMed

Affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK. e.roddy@cphc.keele.ac.uk.

ABSTRACT
This invited paper provides a summary of a keynote lecture delivered at the 2011 Australasian Podiatry Conference. Gout is the most prevalent inflammatory arthropathy. It displays a striking predilection to affect the first metatarsophalangeal joint as well as joints within the mid-foot and ankle. A number of factors are known to reduce urate solubility and enhance nucleation of monosodium urate crystals including decreased temperature, lower pH and physical shock, all of which may be particularly relevant to crystal deposition in the foot. An association has also been proposed between monosodium urate crystal deposition and osteoarthritis, which also targets the first metatarsophalangeal joint. Cadaveric, clinical and radiographic studies indicate that monosodium urate crystals more readily deposit in osteoarthritic cartilage. Transient intra-articular hyperuricaemia and precipitation of monosodium urate crystals is thought to follow overnight resolution of synovial effusion within the osteoarthritic first metatarsophalangeal joint. The proclivity of gout for the first metatarsophalangeal joint is likely to be multi-factorial in origin, arising from the unique combination of the susceptibility of the joint to osteoarthritis and other determinants of urate solubility and crystal nucleation such as temperature and minor physical trauma which are particularly relevant to the foot.

No MeSH data available.


Related in: MedlinePlus