Eliseo Pascual Gómez, emeritus professor of Medicine the UMH and ex-chief of Rheumatology of the General University Hospital of Alicante (Spain) has recently published a research article in the prestigious journal Nature Reviews in Rheumatology. On the nature of chronic and progressive of gout  in the absence of treatment, under the title: “Mechanisms of formation of crystals in the gout. A structural approach”, professor Pascual get relevant data and unknown to allow understanding gout  in breadth as crystal deposit disease. The work lays the basis for understanding how and place are constituted of monosodium urate crystals in the gout. These principles enable a greater understanding of the evolutionary and chronic nature of the disease of gout in the absence of treatment or if it is inefficient.

Articular cartilage surface on collagen fibers of cartilage in a process of very early osteoarthritis. Here the crystals form very orderly rows along ripples in bands of collagen

“Nature of chronic and progressive of gout in the absence of treatment” how is gout formed?

The gout disease appears as acute and painful phases of Arthritis, primarily of various joints of the foot, but also of other joints. Gout is basically due to the formation and deposit of a salt crystals (monosodium urate) uric acid from the body itself, mainly in joints. They are essential high levels of uric acid in blood to the formation of crystals, however, were unknown mechanisms that made possible the formation of these particles and the place of origin of its emergence. That lack of information was that the crystals are dissolved during the process of fixation of tissue, essential to their staining and review by pathologists. Therefore, they do not appear in histological preparations.
 

What is it in study NATURE OF CHRONIC AND PROGRESSIVE OF GOUT IN ABSENCE OF TREATMENT BY PROFESSOR Eliseo Pascual Gómez?

The possibility of the realization of the study of the professor and researcher of the University Miguel Hernández of Elche (Spain), Eliseo Pascual Gómez, was made possible by the appreciation of collagen fibers on the surface of cartilage with a tidy crystals deposit. Subsequently, in carrying out histological preparations through surgical biopsies (cuts after freezing of the tissue without setting), where you can see the conservation of crystals, as well as the reasonable deduction of training mechanisms. All this, coupled with recent data on the specific location of the urate crystals, obtained by ultrasound of high precision, resulting in a full image in the process of formation of these crystals so far unknown.
 

¿How are crystals formed in the disease of gout?

Mainly, crystals are the surface of cartilage joint on cartilage Collagen fibers, which have previously been altered by a process of very early osteoarthritis. In this case, the crystals form orderly rows along ripples that present these bands to be freed and retract. In addition, van forming inside of various tendons, such as:

• the patellar
• el de Aquiles
• oor flexors of the fingers of the hand
• in ligaments
• in places where not occur inflammation of large magnitude are invaluable

Late are becoming nodules (tophi), which initially are crystals of orderly in the tissues. Later grow up to become palpable and reach considerable sizes: can play in different locations of the body, as in the elbow. In addition, they will also be forming internally and only perceive through imaging techniques. The crystals formed on previous crystals, spherical formations, adopt an aspect of range and are common in various natural crystallizations and geogicas formations. The tophi grow next to the bone joint, leads to erosions which can be seen in x-rays of the gout.
The mechanism of the formation of crystals (on surface of the cartilage and tendons inside) are constituted on fibers (fibers “breadwinner” of organs and tissues) collagen in places that present supplementary shaped glass structure. This reduces the energy required for their formation and defines the place where it brings. New crystals already manage to find a place of growth, to begin the training of all.
The findings obtained do not directly affect the scheme of treatment of disease, but do allow the understanding of the same. Sometimes it is perceived as a disease episodic and sometimes present during cases of gouty arthritis. All a direct result of a permanent deposit and long time. Deposit of crystals, in the absence of symptoms, cause local inflammation and it favors the arteriosclerosis and its consequences such as cardiovascular disease, it is common in patients of gout. There are recent reports of greater helplessness in these patients, as a result of arteriosclerosis and the decrease of blood flow in the vessels that provide blood for erection. The professor of the UMH (Spain), Eliseo Pascual, says, “it is useful that citizens know that the treatment of gout is very effective and is today held by cure; from Alicante (Spain) we have made significant contributions to adapt the treatment to the reality of the disease, which we now understand much better.”
 
Visit the article by Eliseo Pascual published here: www.nature.com