Question

All of the following statements about primary gout arthritis are true, except:

• A. 90% of cases are caused by over production of uric acid
• B. Uric acid levels may be normal at the time of an acute attack
• C. Men are more commonly affected than women
• D. Definitive diagnosis requires aspiration of synovial fluid

Hint:

In primary gout most patients are under-excretors, not over-producers.

Answer 1

The Correct Option is A

Think of primary gout as a balance problem between how much urate the body makes and how much the kidney throws out. When the equation tips toward retention, hyperuricemia and crystal disease follow.

The teaching point hidden in option A is the under-excretion versus over-production ratio. In real patients roughly nine out of ten have kidneys that fail to clear enough urate; they are under-excretors. Only a small minority, around one in ten, actually over-produce uric acid (for example with enzyme defects or high cell turnover). Option A claims the opposite, so it is the wrong statement and the answer.

Now confirm the rest. A serum uric acid drawn during a hot flare can read normal because urate has migrated into the inflamed joint and acute illness alters handling, so clinicians never exclude gout on a single normal level. Men dominate the disease because estrogen pushes urate out in urine, sparing premenopausal women. And the one test that proves gout beyond doubt is joint aspiration showing needle-like, negatively birefringent crystals. All three of these match standard teaching and are true.

So the single false line is the over-production claim.
\[\boxed{\text{90\% of cases are caused by over production of uric acid}}\]