In a recent study of gouty subjects, urinary excretion of uric acid was noted to be greater in the symptomatic than in the asymptomatic subjects (1). Since, however, the groups of patients were small and the data unpaired, these observations were not analyzed further. A The present study was designed to extend our previous findings by obtaining paired data from gouty men during symptomatic and asymptomatic phases of their disease, simultaneously eliminating, whenever possible, other factors that might influence uric acid metabolism and turnover.
METHODSOver a 2-year span, data were collected from eleven subjects judged suitable for this study. All were men with previously established diagnoses of primary gout, with no detectable nephropathy, and with totally asymptomatic intercritical intervals. Pertinent data for all subjects are listed in Table I. Only three were later eliminated, two for failure to collect total urine output, and one because of the inadvertent medication with a uricosuric drug during a symptomatic episode. Ten of the subj ects were followed over a single hospital ad-* Work supported by U. S. Public Health Service research grant AI 02757-05 from the National Institute of Allergy and Infectious Diseases, Bethesda, Md. mission; eight were admitted with acute arthritis and were studied before and after therapy with colchicine and relief of symptoms. The remaining two, RC and FC, were admitted for unrelated reasons and developed acute arthritis during the study. The eleventh subject, LM, was seen over two separate admissions, once for acute arthritis, when only acute-phase data were studied, and again, 2 years later, during ambulatory convalescence from myocardial infarction.None of the subjects were on uricosuric drugs before the study. They were all fed a standard low-purine diet from at least 2 days before the start of the study. The daily diet contained 96 g protein, 85 g fat, and 257 g carbohydrate; the purine content was limited to 60 mg contained in one meat course given each day. Dietary intake was supervised daily. Three normal persons fed this diet for 7 to 11 days each stabilized their urinary excretion of uric acid within 24 to 48 hours, and thereafter their daily uric acid excretion did not vary by more than 68 mg from their individual mean 24-hour uric acid excretion. The subjects' total urine output was collected in 24-hour samples starting and ending at 8 :30 a.m. Blood was drawn each day at the same hour. Collection and preservation of urine has been described (6). Uric acid was measured by the spectrophotometric method of Praetorius and Poulsen (7) with uricase, and creatinines were determined by Phillips' modification of the alkaline picrate method (8). Urinary 17-hydroxycorticosteroids were analyzed by the method of Silber and Porter (9).Therapy during the acute phase of the study was limited to nonuricosuric analgesics. The acute phase of the study was terminated by iv colchicine therapy in order to avoid any possible gastroenteritis that might interfere with urine collectio...
