<h3>The Inflammatory Reaction to Sodium Urate</h3> Its Possible Relationship to the Genesis of Acute Gouty Arthritis J. E. Seegmiller, M.D., R. Rodney Howell, M.D., and Stephen E. Malawista, M.D., Bethesda, Md. A CUTE GOUTY ARTHRITIS is a dramatic but relatively uncommon accompaniment of hyperuricemia. Multiple etiologies for the hyperuricemia of primary gout have been defined in recent years.<sup>2,3</sup>During this time, however, the mechanism of acute gouty arthritis has been studied relatively little, with the exception of a notation of the increased urinary excretion of certain purine compounds during the attack.<sup>4</sup>Today the origin and development of acute gouty arthritis remains an enigma. The reputed inertness of sodium urate upon injection into the human has been a primary argument against assigning a role to this substance in the genesis of acute gouty arthritis.<sup>5</sup>Since most previous work has been done with solutions of sodium urate, we have