In attempting to evaluate the association which may exist between hyperuricemia, gouty arthritis, and other disease states, several avenues of approach are open. One may investigate gouty arthritis or other disease states in question when either is severe enough to bring the subject to the specialist or to the hospital. In the case of gouty arthritis this means when it is severe enough to have produced multiple painful attacks, renal stones, renal failure or other complications.Considering the fact that renal stones, hypertension, cholecystitis, etc. are all fairly persuasive arguments in convincing the subject that he ought to come to the hospital, the case selection involved is apparent. The vast majority of reports on the association between gouty arthritis and other diseases are based on this approach and are responsible for the many associations reported in the older literature. These reports are further complicated by statements based solely on clinical impression, right or wrong.By and large, no control groups are offered in thess reports or the groups used as controls are drawn from insurance tables or government tables of mortality which are based on entirely uncomparable methods of subject selection and examination. These reports have been quoted and requoted over the years and have been difficult to escape.For example, one widely quoted reference which is cited to support the contention that hypertension and atherosclerosis are more common in patients with gouty arthritis is, in turn, apparently based on five previous references. Of these one, a study of blood pressure in prisoners and prison guards, and another which is a study of statistical methods of evaluating the prevalence of atherosclerosis, do not mention gout or hyperuricemia. One describes three patients with long histories of gouty arthritis, two of whom were over 70, admitted to a hospital with myocardial infarction. The fourth reports 55 cases of gouty arthritis in a hospital series, 17 of whom had kidney disease and many of whom were uremic and hypertensive. The fifth reference is a statement of clinical impression. In addition, most of the older literature is very difficult to interpret since the studies antedate our knowledge of the effects of fasting, acidosis or small doses of salicylates on uric acid values, and make no attempt to separate the subjects with renal disease, leukemia and so forth. Most of these reports were published in the 1930's or before.I will beg your indulgence, therefore, in refraining from further description of reports of this variety. That is not to say that there is nolt value in reporting what happens in a large number of gouty subjects, whether they 846