Gout attacks are often accompanied by high blood uric acid, but gout does not occur in 100% of people with high blood uric acid. According to statistics, only 5-12% of people with high blood uric acid develop gout. Just as the occurrence of lung cancer is associated with smoking, it is not a given that smokers will develop lung cancer. The occurrence of disease in medicine is usually multifactorial and varies from person to person. In some people who consume high purine foods for a long time, blood uric acid is often elevated, but it is maintained at normal levels due to strong regulatory mechanisms in the body, such as increased excretion of blood uric acid in the kidneys. In normal individuals, blood uric acid concentration is 6.0 mg/dL (women) or 7.0 mg/dL < men). One third of it is excreted from the body by the kidneys and one third is broken down by gastrointestinal bacteria and excreted. Most gout patients have acute gout attacks due to persistently high blood uric acid concentrations (>8.0 mg/dL) combined with decreased renal excretion, which allows supersaturated uric acid to form microscopic crystals and deposit in the joints, so high blood uric acid is the most important biochemical basis for gout attacks. It is important to know that although patients with gout must have hyperuricemia at some point in the course of their illness, in some cases blood uric acid levels are found to be in the normal range during a gout attack, which may be due to a temporary pseudo-normality caused by excessive secretion of adrenocorticotropic hormones during an acute attack, which promotes the excretion of blood uric acid. It may be more helpful to measure uric acid at this time. It is important to note that uric acid testing is only meaningful if the kidney function is normal, because even if the blood uric acid level is high, if the patient’s kidney function has decreased, the blood uric acid cannot be excreted, but instead the uric acid excretion is normal or decreased, resulting in another false normal result. For this reason, blood uric acid levels are now more commonly checked to determine if the patient is hyperuricemic, usually by drawing blood in the morning on an empty stomach. For some people with hyperuricemia, although there are already urate crystals precipitated, the symptoms of gout attacks appear mild or even undetectable due to their reduced immune function and weakened phagocytosis of white blood cells.