Checkpoints in the progression from hyperuricemia to the clinical manifestations of gout

Factors controlling deposition of MSU crystals are not well understood. The acute flare results from production of mature interleukin 1 beta after activation of the NLRP3 inflammasome that occurs after ingestion of crystals by monocytes, which in humans, requires a second signal through TLRs. Flare resolution involves NETs, which bind MSU crystals. The NETs probably contribute to the formation of tophi.