DANIEL J. MCCARTY, M.D., F.A.C.P.
Our understanding of the pathogenesis of gouty inflammation continues to evolve. Elsewhere in this issue (p. 230), Simkin lucidly outlines an hypothesis to account for the localization of sodium urate crystals in the first metatarsophalangeal (bunion) joint as opposed to other dependent small joints (1). He assumes a constant association of urate crystals and acute gout. This association has been widely accepted since it was first described by Hollander and me in these pages 15 years ago.
In my own experience, phagocytosed urate crystals have almost always been found during the acute attack in the joint fluid, with the rare
MCCARTY DJ. The Gouty Toe-A Multifactorial Condition. Ann Intern Med. ;86:234–236. doi: 10.7326/0003-4819-86-2-234
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Published: Ann Intern Med. 1977;86(2):234-236.
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