Many attempts have been made to explain the two chief symptoms of gout, the occurrence of gouty deposits or tophi, on the one hand, and the origin of the acute gouty inflammation or paroxysm on the other.
The tophi, which usually develop slowly and painlessly in the skin or in fibrocartilage, consist chemically chiefly of mononatrium urate with some admixture of monocalcium urate (Ebstein and Sprague.1) The anatomy of the nodule has been carefully studied (Riehl,2 Freudweiler3). Along with the uratic deposit in the center there is necrosis; this is surrounded by a connective-tissue capsule in which "foreign-body" giant cells may occur; accumulations of lymphoid cells are met with about the adjoining vessels; doubly refractive granules may be seen inside the giant cells; a few crystals are present in the uninjured tissue at the periphery of the nodule. Precisely similar nodules can be produced experimentally by
TRUTH AND POETRY CONCERNING URIC ACID. JAMA. 1905;XLIV(18):1451–1453. doi:10.1001/jama.1905.02500450039006
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: