Is it possible to have gout without hyperuricemia? (Although very rare, it still requires evaluation based on clinical symptoms)

Absolutely possible! Don't be fooled by a "normal uric acid" reading on your lab report; this is quite common among gout patients.

Think of it this way: A gout attack occurs when uric acid "wreaks havoc" in your joints, forming many needle-like crystals. This is why your joints become red, swollen, and excruciatingly painful.

During the acute attack, a large amount of uric acid in your bloodstream "rushes" into the joints to form crystals. It's like the uric acid in your bloodstream, which is like a "river channel," suddenly floods into your joints, which are like a "reservoir." When you get a blood test at this time, it measures the "water level" in the "river channel." Because a large amount of uric acid has moved into the "reservoir," the "water level" in the "river channel" (i.e., your blood uric acid level) might appear normal, or even low.

Therefore, experienced doctors diagnosing gout don't just look at the blood uric acid level alone. They place more importance on your clinical symptoms:

Is it a sudden onset of severe pain? Pain that feels like a knife cut or a bite.
Is it a single joint that is red, swollen, hot, and painful? The big toe is most commonly affected, but it can also be the ankle, knee, etc.
Does it occur in the middle of the night or early morning? Many people are woken up by the pain in their sleep.

If your symptoms are very typical, even if your blood uric acid is not high, doctors will strongly suspect gout. The most accurate diagnostic method is actually to draw a small amount of synovial fluid from your swollen and painful joint, examine it under a microscope, and if uric acid crystals are found, the diagnosis can be directly confirmed.

Once this acute gout attack subsides and the pain is gone, recheck your blood uric acid level after some time. The value at that point will often reflect your body's true level, and it will likely be elevated.

So remember, when diagnosing gout, symptoms are more important than the blood uric acid level during an attack. Don't let a single normal test result make you complacent.