Serum uric acid levels measured during an acute gout flare are frequently normal or lower than baseline due to increased renal excretion, meaning a normal reading does not rule out an acute gouty attack.
The retrieved literature clearly supports the claim that serum uric acid levels can be falsely normal or significantly lower during an acute gout attack. Paper [4] demonstrates that a substantial percentage of patients present with normal serum urate levels during acute flares. Paper [9] confirms prospectively that serum uric acid levels drop significantly during an acute flare compared to the remission stage due to upregulated urinary excretion. No papers refute this well-established clinical phenomenon.