LIVER FUNCTION AND SERUM PROTEIN STRUCTURE IN GOUT*

THE medical literature of the past century contains numerous references to the supposed role of the liver in gout.7 through 15'23'24'80'31'42'50'55'62'63'79 Three types of hypothesis have been presented: (1) that gout results from an isolated disturbance in some hepatic enzyme, (2) that gout results from chronic diffuse hepatic impairment, and (3) that hepatic impairment is a frequent visceral complication of gout. The first hypothesis is as yet dif-ficult to evaluate, since suitable methods of study have only recently become available.31'82'33 The latter two hypotheses may be evaluated by means of the known sensitive liver function tests. The present study was undertaken to determine the frequency and pat-tern of abnormal hepatic function in gout. A detailed study of serum protein partition was carried out to check those tests which depend primarily upon serum globulin structure and to aid in comparing changes in gout with those reported in rheumatoid arthritis. SUBJECTS Forty-three patients studied were classified in four groups: (1) interval gout, (2) acute and subacute gouty arthritis, (3) chronic gouty arthritis, and (4) gout with known complicating disease. A patient with an acute exacer-bation of a chronic gouty arthritis was considered to be in Group 2. The fourth group included only those patients whose complicating disease was of such a nature that it might be expected ordinarily to lead to hepatic involve-ment. Group 4 included two patients with chronic hepatitis presumably due to alcohol, one with chronic congestive heart failure, one with long-standing chronic ulcerative colitis, one with chronic hepatitis following infectious hepatitis, and one with idiopathic lipemia. Three patients studied both dur-ing an acute episode and during remission appear in two groups. RESULT