Gout Without Hyperuricemia

ACUTE GOUTY arthritis can rarely present with persistently normal serum urate levels. The following case illustrates the diagnostic and therapeutic misadventures that can occur when acute gout is not considered because of normal uric acid levels. The pathophysiologic characteristics underlying urate crystal deposition can be readily explained by the physicochemical properties of sodium urate. Report of a Case An 88-year-old man presented in a wheelchair to a rheumatology consultation clinic on July 15,1992. He had noted onset of pain and swelling in his right foot in early April 1992, 48 hours after his toenails had been trimmed by a podiatrist. His entire foot was swollen and so painful that it could not bear weight. He was taking codeine every 4 hours for pain control. A presumptive diagnosis of gout had been made by an internist on July 15, 1980, because of acute podagra responsive to therapy with a nonsteroidal anti-inflammatory