Chapter 43
Hyperuricemia and Gout
Urate crystals and the disease of kings
Hyperuricemia and Gout — Defined
Hyperuricemia is a serum uric acid level more than two standard deviations above the population mean (upper limit of normal ~7 mg/dL by the uricase method; ~1 mg/dL lower in women). Gout is a disease of recurrent painful acute attacks of urate-crystal-induced arthritis; it may include tophi (deposits of monosodium urate) in joints, cartilage, and kidneys, and uric acid nephrolithiasis. Most patients are men (7-9x); women are usually postmenopausal.
Gout is caused by MONOSODIUM URATE crystals depositing in joints. The upper limit of normal serum uric acid is ~7 mg/dL, and virtually all gout patients exceed it. But hyperuricemia alone is NOT gout — about two-thirds of hyperuricemic people stay symptom-free. Associated conditions include obesity, hypertension, hyperlipidemia, diabetes, and alcohol use.
Hyperuricemia Is Not Gout
A high uric acid level (> 7 mg/dL) is a risk factor, but two-thirds of hyperuricemic patients never develop symptoms. Gout requires actual urate DEPOSITION — arthritis, tophi, or stones. This is why asymptomatic hyperuricemia is usually not drug-treated.
📖 “Hyperuricemia: uric acid >2 SD above mean (ULN ~7 mg/dL, lower in women). Gout: recurrent urate-crystal arthritis, tophi, nephrolithiasis. Men 7-9x, women postmenopausal. Associated: obesity, HTN, hyperlipidemia, diabetes, alcohol.”