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Serum urate during acute gout.

Naomi Schlesinger¹, Josephine M Norquist, Douglas J Watson

¹Department of Medicine, Division of Rheumatology, UMDNJ/Robert Wood Johnson Medical School, MEB 474 PO Box 19, New Brunswick, NJ 08903-0019, USA. schlesna@umdnj.edu

The Journal of Rheumatology

|April 17, 2009

Summary

Acute gout attacks can occur even with normal serum urate (SU) levels, challenging traditional diagnostic assumptions. This study highlights that low SU does not rule out gout flares, suggesting other factors are at play.

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Area of Science:

Rheumatology
Clinical Pharmacology
Gout Pathophysiology

Background:

Gout is a common inflammatory arthritis characterized by hyperuricemia.
Serum urate (SU) levels are traditionally used to diagnose and monitor gout.
The relationship between SU levels and acute gout attacks requires further clarification.

Purpose of the Study:

To determine the frequency of normal serum urate (SU) levels during acute gout flares.
To analyze SU levels in a large cohort of patients experiencing acute gout.
To investigate the impact of chronic allopurinol use on SU levels during acute gout.

Main Methods:

Analysis of data from two large randomized controlled trials on acute gout treatment.
Assessment of serum urate levels in patients during acute gouty attacks.
Combined analysis of etoricoxib and indomethacin treatment groups due to similar efficacy.

Main Results:

In a cohort of 339 patients, 14% had normal SU (
Patients on chronic allopurinol had significantly lower baseline SU levels compared to non-users (7.1 vs 8.5 mg/dl, p<0.001).
Acute gout attacks occurred even when SU levels were below the urate saturation point of 6.8 mg/dl.

Conclusions:

Normal serum urate levels at the time of presentation do not exclude an acute gout attack.
The persistence of tophi and an increased body uric acid pool may contribute to gout flares despite low SU.
Further research is needed to correlate SU levels with the body uric acid pool and its dynamic changes during acute gout.