Each uric acid crystal is microscopic.
You never get to see them, let alone watch them get beaten.
Now you can.
EULAR (EUropean League Against Rheumatism) has produced 6 still images of a uric acid crystal meeting a white blood cell.
I used 4 of these pictures in the image showing on the right. See a full size version of my uric acid crystal graphic below
You can see more images below, but first let me explain some very important points revealed by these pictures.
- No direct nerve effect
- Trapping a single crystal has no noticeable effect. These microscopic crystals are invariably described needle-like. You can see from the pictures that this is true. However, needle-like implies a stabbing pain, which is usually a direct attack on nerves. Uric acid crystals are too small to affect nerves.
Pain (acute gout) is only caused when many are trapped together. When many white blood cell attack foreign particles an inflammatory reaction occurs. This Reaction causes swelling that causes pain, as part of my U-D-R-P process.
- Intercritical Gout
- Crystals can be trapped between acute gout attacks. If only a few, there will be no side effects, or only a little tingling / numbness.
Deposits can build up slowly over time without you noticing. Joint damage and pain (Chronic / Tophaceous Gout) can occur if this is left unchecked. See the Uric Acid Deposits part of my U-D-R-P process for more information.
- Down but not out
- Trapping does not “kill” crystals. If they start to dissolve the white blood cell shield will fall away, revealing the crystal to the immune system for another attack. This is why pain relief must always be considered alongside long term gout prevention.
Uric Acid Crystal Images From EULAR
The images used in my sequence were taken from a set of six images showing the progress of white blood cells as they engulf uric acid crystals.
Whilst searching for those uric acid crystal pictures, I found a relevant report showing the process in more details. The pictures contained in the report are not quite as clear, but the explanation of the process is very detailed, though somewhat jargon filled. I’ll paraphrase the conclusion as:
The sequence of events that may start the inflammatory reaction in acute gout has been investigated with specific reference to engulfing of urate crystals by large white blood cells and the results have shown:
- that white blood cells avidly ingest small uric acid crystals
- that this causes the rapid loss of granules and disintegration of the white blood cells
- that fresh white blood cells ingest the debris and crystals liberated by the dead cells, and in their turn loose granules and die, thus possibly establishing a vicious circle in the system.
Leave this page to browse the uric acid crystals in the Understanding Uric Acid Section.
Uric Acid Crystal Pictures References
- Title: Observations on phagocytosis of urate crystals by polymorphonuclear leucocytes. Author: Rajan KT. Published: Ann Rheum Dis. 1975 Feb;34(1):54-61. Uric Acid Crystals Meet White Blood Cells