The trajectory of gout: mapping pathogenic cell states from flares to tophus

Abstract The clinical course of gout is typically divided into four stages: asymptomatic hyperuricemia, gout flares, intercritical gout and tophaceous gout. However, the cellular and molecular mechanisms driving transitions between these stages remain unclear. Current clinical practice lacks stage-specific precision therapeutic strategies. In recent years, the development of single-cell sequencing technologies has provided tools to reveal dynamic cell state transitions during gout progression. This review synthesizes existing single-cell evidence to systematically delineate the immune and stromal cell landscapes across the stages of gout, and explores their roles in inflammation initiation, spontaneous resolution, and tissue remodeling, with the aim to provide a theoretical framework for stage-adapted therapies.