To detect the serum free fatty acid (FFA) concentration in patients with primary gouty arthritis (GA) and to explore the correlation between FFA and gout flare. Sixty patients with acute GA, 60 patients with GA remission, 60 patients with asymptomatic hyperuricemia (HUA), and 60 normal controls were enrolled in this study. Serum FFA concentration was detected by enzymatic determination in four groups, and the relationship between serum FFA, serum urate (SU), and other clinical and laboratory parameters was analyzed. (1) Serum FFA concentration was significantly higher in the acute GA than in the GA remission, the asymptomatic HUA, and the normal control (H= 72.191, P< 0.001). (2) There were no significant difference in serum triglyceride and low-density lipoprotein cholesterol (LDL-C) concentration between the acute GA, the GA remission, the asymptomatic HUA, and the normal control group. FFA may be involved in the acute attack of gout in conditions of monosodium urate crystal deposition in the joints. Triglyceride and LDL-C may not be involved in the acute attack of gout. FFA may be used as an indicator to monitor the status of GA in clinical.Key Points• Lin Pei and Linfeng Xie designed the randomized controlled trial and were responsible for the development of the protocol.