Total Joint Fluid Urate in Gout

Synovial fluid urates are traditionally measured as supernatants, and levels are reported to be comparable to serum levels.We have decided to attempt to define a more accurate parameter of gouty urate load in the joint fluid.In 23 gouty joints of various activity, the urate level was determined by both the traditional method and by heating and agitation to dissolve crystals yielding total joint fluid urate (TJFU).TJFU was higher than the serum level or traditional urate level, and the gradient (TJFU-synovial fluid urate) was proportional to gouty activity.We propose that TJFU is more representative of the pathophysiology of gout and deserves further evaluation of its implications.