[Pathogenesis of gouty arthritis]

The urate crystal stands in the centre of the pathogenesis of gouty arthritis. External influences, such as changes of temperature and mechanical loads as well as factors, which lead to a short term change of the level of uric acid in the serum, such as alcohol, meals rich in purine, uricosurics and saluretics are, indeed, able to induce an attack of gout, but they are no obligatory prerequisite. The granulocytes are to be regarded as the second important prerequisite of the crystal arthritis. They become effective either via the process of phagocytosis or their cell membrane produces prostaglandins, the formation of which is evoked by electrostatic forces of the crystals. Mediators, such as kinins, Hageman's factor and complement are mainly responsible for the initial pain reaction, vasodilation and leukotaxis, lysosomal enzymes evoke the secondary changes at the joint.