The Metabolism in Gout 



JOSEPH H. PEATT 



BOSTON 



Introduction 



Gout is a disease associated with a disturbance of the uric acid metabo- 

 lism. The one unchanging feature that characterizes the disease ia the 

 deposition of sodium urate in the tissues. This fact is the firm rock in the 

 quicksands of theory. 



An immense amount of work has been done during the past decade 

 on the metabolism in gout with the aid furnished by advances in biochem- 

 istry and by the discovery of accurate methods of blood analysis. Many 

 new facts have been acquired, but the statement von Noorden(/) made in 

 summing up the state of knowledge of the subject in the second edition 

 of his handbook in 1907, is still true in 1921 : "A clear insight into the 

 nature of the disturbance of metabolism in gout has not been attained." 



The doubt often expressed in the past as to whether uric acid is ac- 

 tually the m&teria peccans in gout has not been dispelled by recent investi- 

 gations. Where the disease takes its origin is unknown. It may be in 

 the kidney and result from renal retention of uric acid, as originally 

 Garrod(d) thought. Many hold this view. The disease on the other hand 

 may primarily be a disturbance of purin metabolism with secondary 

 changes in the kidneys. This theory has the most adherents. A third 

 possibility is that the disease begins in the joints themselves (Bass and 

 Herzberg). An old theory recently revived to explain newly discovered 

 facts is that gout has its basis in a special form of hepatic insufficiency 

 (Chauffard, Brodin and Grigaut). 



In view of the close relation between gout and uric acid it is neces- 

 sary to make a study of nucleic acid metabolism in health and in disease 

 with the hope that it will later reveal the exact nature of the disturbances 

 in gout. Since the chemistry of nucleic acid and the purins is dealt with in 

 another article in this work, we shall take up here only the chemical 

 facts that are important for our discussion of gout. Chalmers Watson held 

 that gout is an infection and that the toxin or toxins generated disturb 

 metabolism in a way favorable to the deposit of uric acid. Llewellyn be- 

 lieves that local foci of infection give rise to gouty arthritis in individuals 

 in whom there is an "inherent abnormality or instability of nuclein 

 metabolism." 



411 



