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Correlation of Comorbidities and Immune Cellular Response in Biopsies and Surgical Resections of Gout

Syeling Lai, and Xiaodong Zhou

Background: There are many published studies of comorbidities and in vitro analysis of inflammatory mechanism in gout, but only few in vivo tissue examinations for immune response cells were reported. The association of comorbidities and immune cell response has not been well documented. Our objective is to examine the immune cell types and quantity in gout tissue, identify clinical parameters of gout associated risk factors in corresponding patients, and analyze the association of individual cell type with comorbidities.

Methods: Biopsied or resected tissues from 33 patients diagnosed as gout were used for this study. Cell count was performed on Hematoxylin and Eosin stained sections for macrophages, plasma cells, neutrophils and on immunostained slides for T- and B-lymphocyte.

Results: The mean patient age was 62 year-old with 57.6% patients over 60 year-old. Mean serum uric acid level was 8.5 mg/dl. The average body mass index was 30.6 kg/m2. Majority of the patients had history of hypertension (93.9%). There were 34.4% and 28.1% of patients admitted history of smoking and alcohol intake, respectively. Hyperlipidemia and diabetes mellitus were seen in 78.8% and 45.5% of patients, respectively. H and E stained sections demonstrated the crystalline deposits rimmed by palisading multinucleated giant cells, macrophages, and chronic inflammatory cells. Average cell counts of T-cells, B-cells, multinucleated giant cells, mononucleated macrophages, plasma cells and neutrophils are: 33.0, 11.8, 7.3, 26.8, 0.38, and 7.4 cells/ High Power Field respectively. Of significant values are associations of plasma cells and B-cell with hypertension, T-cell with hyperlipidemia, uric acid with smoking as well as multinucleated giant cells with uric acid.

Conclusion: Most of the gout patients showed an elevated uric acid level. The participating inflammatory cells in local tissues were predominantly T-lymphocytes, macrophages and multinucleated giant cells. Comorbidity factors including hypertension, hyperlipidemia, diabetes, smoking and drinking may precipitate gout by stimulating immune cell proliferation.