Uric Acid Variations in Acute Gout
Generally speaking, there appears to be a consensus of opinion on the following points:—
(1) That in the intervals between acute attacks of gout the elimination of uric acid lies within the normal limits, but that
(2) For one or two days prior to an acute attack an appreciable decline in the output of uric acid occurs. This, however, is not so marked as the subsequent
(3) Increased output of uric acid during the acute attack. According to Magnus Levy the increase may reach from 0·3-0·5 gram, daily, and more, and may sometimes last for a week or even two.
(4) Following attack a tardy decline in uric acid output to former level.
To sum up, during an attack of acute gout the uric acid output stands at a relatively low level between the paroxysms. But one or two days before the oncoming attack a diminution in uric acid output ensues. In contrast with the outbreak of the attack, the uric acid excretion increases markedly, this enduring for a week or more, when the output again declines. The augmented output during the paroxysm is more constant than the diminished excretion antecedent thereto. Now, while it may be taken that the foregoing variations in uric acid output, prior, during, and subsequent to, acute attacks, obtain as a general rule, such behaviour is not invariable; for, unfortunately, as Wells reminds us, instances are met with in which “the uric acid excretion shows no variation from that of normal persons.”