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Logan and colleagues recently re-emphasised that serum uric acid is often within the normal range during the acute episode of gout and suggested that serum urate invariably falls during episodes.1 We too have studied the frequency of normal uric acid concentrations during an acute episode.2 Thirty nine per cent of our patients as compared with 43% of Logan’s patients had serum uric acid concentrations within the normal range during the acute episode. In contrast with the statement by Logan and colleagues that serum urate invariably falls during episode we found that serum uric acid concentrations can either be higher or lower with acute episodes than during the intercritical period. Patients receiving long term allopurinol treatment tended to be more likely to have lower serum uric acid during the acute episode (p<0.01). Patients not receiving allopurinol treatment tended to have higher serum uric acid concentrations during the acute gouty episodes than during the interim (p<0.005). More study is needed with more sequential observations examining the relation between timing of episodes and changes in serum uric acid.
Schlesinger and colleagues confirm our findings on the frequency of a normal serum uric acid in acute gout. However, they have misread our statement concerning the comparative serum uric acid values during and between episodes. On the basis that in 70% of patients the serum uric acid was lower during the acute episode we concluded that the serum uric acid “usually” falls at that time but not “invariably” as misquoted by Schlesinger. Their error is understandable (and forgivable!) as we did state in an earlier communication1-1 that the serum uric acid “almost invariably” falls during acute gout. We supported this statement with the data in figure 1-1 that appeared in our presentation but not the published abstract. We do agree that more sequential studies of this kind are needed before deciding on the correct qualifying adverb.
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