THE INFLAMMATORY PROCESS IN ACUTE GOUTY ARTHRITIS. I. ACTIVATION OF HAGEMAN FACTOR BY SODIUM URATE CRYSTALS.

Abstract

Abstract Monosodium urate crystals, similar to those found in the affected joints of patients with acute gouty arthritis, were found to enhance clotting by the activation of Hageman factor, the initial protein component in the intrinsic clotting mechanism. Other crystals found to enhance clotting include calcium pyrophosphate, hypoxanthine, and sodium orotate, all of these crystals possess a negative surface charge. Activated Hageman factor can initiate a series of reactions in plasma that result in the formation of kinin-like inflammatory mediators. It is proposed that monosodium urate and calcium pyrophosphate crystals initiate acute arthritis by activating Hageman factor in synovial fluid which causes increased capillary permeability and an accumulation of leukocytes. The inflammatory response is then perpetuated by additional inflammatory mediators produced by the accumulation of leukocytes.