Gouty arthritis (GA) is an inflammatory disease arising from autoimmune responses, with a complex pathogenesis. Research indicates that monosodium urate (MSU) crystals, formed by prolonged elevated uric acid levels, play a crucial role in the development of GA. MSU crystals can induce immune responses that promote inflammation, oxidative stress (OS), neutrophil extracellular traps, apoptosis, and macrophage polarization within joint tissues. These immune responses cause severe damage to joint cells and tissues, further inducing the onset of GA. Existing research indicates that the “autophagy-gout” intervention mechanism aligns closely with the traditional Chinese medicine (TCM) theory of “struggle between healthy qi and pathogenic qi”. Activating autophagy stimulates the body's righteous energy by degrading damaged cells and proteins, maintaining cellular homeostasis, and promoting adenosine triphosphate production for energy supply. This enables the righteous energy to self-regulate, self-repair, and resist pathogenic factors, thereby improving gout conditions. Extensive TCM research demonstrates that active herbal extracts such as dihydrodanshikeniol I and diosgenin total saponins, along with TCM formulas like Duhuo Jisheng Decoction and Danggui Sini Decoction, can effectively inhibit the aforementioned immune responses, significantly alleviate inflammation and OS in GA joint tissues, and reduce joint pain and swelling. This suggests that TCM intervention targeting autophagy may represent a promising therapeutic avenue for GA. Based on this, this paper details the mechanisms of autophagy in GA and potential intervention targets, aiming to provide new effective approaches for developing GA treatment strategies.

gouty arthritis  /  traditional Chinese medicine  /  autophagy  /  struggle between healthy qi and pathogenic qi  /  inflammation  /  oxidative stress  /  neutrophil extracellular traps  /  apoptosis  /  macrophage polarization