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84 The JHR has been variously attributed by authors for more than a century to release of toxins by dying spirochetes, hypersensitivity to spirochetes, removal of dead spirochetes by phagocytic cells, complement activation, DIC, and mediators of inflammation including cytokines and histamine

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This occurs when MSU crystals are deposited in synovial fluid and cartilage, triggering intense inflammation and symptoms of gout, usually starting in the big toe