Normal serum uric acid gout: a neglected and challenging condition.

Xiu Hong Yang, Xiao Li Zhan, Qing Xia Xuan, Hui Min Jin, Zhi Bin Ye

Journal: Frontiers in endocrinology 2026;17():1873856

PMID: 42369066

Abstract

During acute gout flares, serum uric acid (SUA) levels may remain within the normal range, making diagnosis based solely on SUA unreliable. A systematic evaluation incorporating clinical symptoms and imaging (ultrasound, dual-source CT) is essential to detect monosodium urate (MSU) crystal deposition. Normal-SUA gout often presents with more pronounced inflammation, fever, elevated white blood cell count and C-reactive protein, and may occur after surgery or hemodialysis. Tophi can appear at typical or atypical sites (e.g., face, neck). No specific treatment guidelines exist, but lowering SUA to <360 μmol/L (6 mg/dl) reduces gout flares and promotes MSU dissolution. Emerging therapies-including anti-IL-1β monoclonal antibodies, NLRP3 inhibitors, uricases, and green tea components-show promise in controlling attacks and dissolving crystals without affecting SUA levels.

Address: Department of Nephrology, Huadong Hospital, Fudan University, Shanghai, China.; Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Fudan University, Shanghai, China.; Department of Nephrology, Shidong Hospital affiliated to University of Shanghai for Science and Technology, Shanghai, China.; Shanghai Dong Ji Fresenius Hemodialysis Center, Shanghai, China.; Shanghai Dong Ji Fresenius Hemodialysis Center, Shanghai, China.; Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Shanghai, China.

DOI: 10.3389/fendo.2026.1873856

MeSH Terms: Humans, Gout, Uric Acid