Serum urate during acute gout.
OBJECTIVE
To study the frequency of normal serum urate (SU) levels during acute gout in the largest studies of acute gout treatment to date.


METHODS
Data collected from 2 randomized controlled clinical trials assessing the efficacy of etoricoxib or indomethacin for 7 days in acute gout were used to assess SU levels during acute gouty attacks. Efficacy was similar with both agents, so both groups were combined for analysis.


RESULTS
A total of 339 patients were enrolled in the 2 studies; 94% were male; mean age was 50.5 years. At baseline, 14% of patients had a "true" normal SU (<or=6 mg/dl) and 32% had SU<or=8 mg/dl during acute gout. Baseline mean SU was 7.1 versus 8.5 mg/dl (p<0.001) in those taking allopurinol versus nonusers. Patients taking chronic allopurinol were more likely to have lower SU at baseline compared to those not taking chronic allopurinol (p<0.001) during the acute attack.


CONCLUSIONS
A normal SU level at presentation does not exclude an acute gouty attack. In the largest studies of acute gout to date, attacks still occurred despite SU levels being below 6.8 mg/dl, the saturation level for urate. This may be attributed to persistence of tophi and an increased body uric acid pool. Additional studies are needed to determine the correlation between SU and the body uric acid pool as well as the relationship to timing of changes during acute gout.
Department 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
Naomi
N
Schlesinger
Josephine M
JM
Norquist
Douglas J
DJ
Watson
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D000077613:Etoricoxib; D005260:Female; D006073:Gout / Q000097:blood* / Q000188:drug therapy; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000627:therapeutic use; D013450:Sulfones / Q000627:therapeutic use; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood*; D055815:Young Adult
D016861:Cyclooxygenase Inhibitors; D006074:Gout Suppressants; D011725:Pyridines; D013450:Sulfones; D014527:Uric Acid; D000077613:Etoricoxib; D007213:Indomethacin