Chronic Tophaceous Gout : Gross Pathology

Crystal-induced arthritis is a group of acute and chronic inflammatory joint disorders caused by deposition of crystalline material within and around the joints. The prototypic example is gout. Endogenous Crystals: The crystals may be monosodium urate (Gout), calcium pyrophosphate dehydrate (Pseudogout), or calcium phosphate. Exogenous Crystals: The exogenous material that may trigger arthritis include corticosteroids, talcum, and biomaterials used in joint prosthesis (silicone, polyethylene, and methyl methacrylate). The underlying metabolic abnormality in gout is hyperuricemia. High plasma urate levels lead to supersaturation of synovial fluid which is a poor solvent for monosodium urate (MSU). The lower temperature in peripheral joints further decreases solubility and promotes crystal formation. Materials in and around joints, including collagen fibers, chondroitin sulfate, proteoglycans and cartilage fragments act as nuclei for crystals. Once deposited, the MSU crystals trigger cytokine-mediated tissue injury and inflammation that eventually destroys the articular cartilage.