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Dale S. Feldman* and Allan S. Myerson

Background: Crystallization of monosodium urate (MSU) is the cause of gout as well as is the cause of about 10% of kidney stones. The focus of this paper is on altering the crystallization of MSU, which occurs in the affected joint space. It is generally accepted that the inflammation caused by the MSU crystals leads to the clinical signs of gout: swelling, redness, and pain. Developing treatment and prevention strategies are hampered by not knowing the exact mechanisms. It is known, however, that the inflammatory phase can be controlled by limiting the size and amount of crystals formed. It is also known that only 2 to 36% of hyperuricemic individuals get gout; suggesting that there are chemicals found in the body that can prevent or limit crystallization in hyperuricemic individuals. This study was designed to look at the ability of various chemicals to modify the crystallization of MSU. Methods and findings: It was found that vitamins (riboflavin, pyridoxine HCL, and β-carotene), some dyes (methylene blue, and fuchsin), calcium, and xanthine were able to limit crystal size by adsorption on the surface of the growing crystal. Both niacin and calcium were able to limit crystal size by altering the solubility of MSU. Lysozyme was able to degrade the crystals to limit their size. Conclusions: Although these compounds show promise for drug therapy, there are still many steps required to determine if these compounds could be used clinically to significantly reduce the number of MSU crystals larger than 0.5 μm, and do so with minimal side effects. It also would require further tests to determine, if the difference in serum level of these compounds, among hyperuricemic individuals, is responsible for determining the likelihood of getting a gout attack.


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