Uric Acid Levels and Gout

If you have gout, it is important to get your uric acid levels tested regularly.  This is important for a couple of reasons.  First, if you are taking medication, or even natural remedies to lower uric acid levels, you want to make sure that they are actually working.  You also want to make sure that you are maintaining a healthy uric acid level – too much uric acid and gout can occur (bad) – too little uric acid and neurological issues can occur (rare, but worse).

Second, uric acid levels can fluctuate wildly, from day to day, even hour to hour.  A blood test gives you a snapshot of what your uric acid level is at that moment.  You could be having a good day and your uric acid level is low.  This might make you feel as though you do not need to take so much medication and scale back.  Unfortunately, this will likely result in a gout attack.

At the other end, you could have been having a bad day when you where tested and decide to take more uric acid lowering medication and end up taking too much.  Although its very unlikely that you would drive your uric acid down to the point where you would start having neurological problems (below 2.16 mg/dL or 120µmols/L), you still probably want to take the minimum amount of medication needed to stop your gout attacks.

This is why it’s important to get tested frequently.  With frequent testing, you can average out your test results to see how you are doing over all.  Below is a chart from a study where the subjects where tested every month for a year.  These people where not on uric acid lowering medication and shows how much uric acid levels can fluctuate over time.

Uric acid level can fluctuate significantly over time. This chart shows the range of uric acid levels in 12 people that where tested once a month for a year.

Uric acid level can fluctuate significantly over time. This chart shows the range of uric acid levels in 12 people that where tested once a month for a year.

One gout expert I interviewed mentioned that those with gout should know their uric acid level like someone with diabetes knows their blood sugar level.

Hopfully, you know by now that the key to effectively stopping gout attacks is to keep your uric acid level below 6mg/dL (333µmols/L).  If you didn’t, keep reading the posts on this site starting with Gout Basics.  If your uric acid level is consistently below 6mg/dL (333µmols/L), there is no way uric acid can crystalize in the body.  No crystallization, means no gout attacks.

Spikes in uric acid levels can also trigger an attack any time even if you are doing a good job of controlling your level.  Even if you are taking uric acid lowering medication and your uric acid level is consistently below 6mg/dL (333µmols/L) you can trigger an attack by causing a sudden spike in uric acid levels.

How?  You can often hear me yelling that gout is NOT caused by diet – it’s a genetic problem.  However, that’s not the same as saying diet has nothing to do with gout.  If you drink a six-pack of beer and gorge yourself at the all-you-can-eat seafood buffet, you will cause your uric acid levels to spike and this can cause a gout attack – even if you are taking uric acid lowering medication and have not had a gout attack in years.  Even if you don’t make a pig of yourself, if your uric acid levels are borderline, then it won’t take much to make conditions right for an attack.  As alway, the key when talking about diet is not necessarily to restrict the foods you eat, but to eat in moderation!  If you eat thirty shrimp that’s not moderation – four or five is.  Drinking a six-pack is not moderation – one or two beers is.  Having that one or two beers every day is not moderation – drinking it on occasion is.

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  1. #1 by Burton Abrams on May 9, 2009 - 6:38 am

    Hi Vic,

    I am repeating here my criticism of medical practice that I have told you about privately regarding the measurement of blood uric acid levels. There is no standardization in current practice for the conditions under which serum uric acid is measured – the amount of time elapsed since last eating, what was eaten, the amount of time elapsed since awakening from sleep.

    Contrast this helter-skelter approach to the procedures used for measuring blood sugar. These results are interpreted based on whether or not the patient has fasted overnight, or even with the more controlled glucose tolerance test. At present, knowing your serum uric acid levels has much less meaning than than knowing your blood sugar levels.

    There is a way that a gout flare can develop even at a time when serum uric acid concentration is below 6 mg/dl. High serum uric acid concentration is required to form the urate crystals in a joint that are the direct cause of gout. But once formed, these crystals dissolve extremely slowly – over many months. But a gout flare lasts typically 3-10 days. Why doesn’t it last until the crystals are dissolved? Because the immune system coats the crystals with a protein sheath so that their presence is no longer detected by the gout inflammasomes. If that sheath is somehow ruptured, a new gout flare will occur until after the breach is repaired, even though the serum uric acid level may be below 6 mg/dl. The rupture can occur from physical injury, as has happened to me at least twice. The rupture can occur chemically, as often happens when an uricosic drug such as allopurinol is started at too high a dosage. In these cases, the gout flare often starts during waking hours. In the case of gout flares that develop during sleep, my claim is that they are usually the result of a flare in serum uric acid above 6 mg/dl resulting from the hypoxia of sleep apnea.

  2. #2 by Victor Konshin on May 15, 2009 - 1:54 pm

    Burton, Very good points. I agree that standards need to be developed on how properly measure uric acid levels. This is definitely a problem. I also agree with your comments on uric acid crystal dissolution. Starting uric acid lowering medication at very low doses and increasing slowly are key to preventing attacks during this time. And, of course, being screened for sleep apnea is important.


  3. #3 by john bailley on June 30, 2010 - 10:40 am

    what is sleep apnea?

  4. #4 by Brad on August 4, 2010 - 3:09 pm

    I have personally had gout for 20+ years. I was diagnosed in my 30′s with two different kidney diseases. The worst gout flares I’ve experienced in my life, I had to go to the ER for the pain. (Doctors don’t really try to address the pain, only the underlying uric acid levels.) Anyway, both times my blood uric acid levels were normal or lower than 6mg/dl. Both times I was released and told to make an appt. with an orthopedic surgeon, because I must have injured myself and not been aware of it. I remind you, these were acute attacks where I was crying like a baby and my knee was as large as a cantaloupe. Waited the required week to get into an appt. without any pain medication. The ortho did needle aspirations because he actually believed me when I said I had not injured myself. Low and behold, Lab test concluded my fluid aspirations were indeed gout, very bad gout. Aspirated 2 times in 3 days and it looked like buttermilk. I’m told normal fluid should look like very light straw colored urine. The ortho stated he hates blood uric acid level because they are so inaccurate at showing a true attack of gout. You are doing a disservice by carrying on about the importance of blood uric acid levels!

  5. #5 by Rob Ladd on August 20, 2010 - 9:42 am

    I have suffered from gout for 10 years. When the first sign of a gout flare was felt, I would immediately start Indomethicin to reduce the potential pain. I would then take that med as perscribed every 8 hours including at least 8 hours after the swelling had disappeared. After all this time I finally approached my physician with the concept of lowering Uric acid levels. I was perscribed Uloric one month ago. 3 or 4 days after commencing this regimen, I had a gout attack in the left elbow. This lasted 10 days. I expected gout flares from the information include with the Uloric. Immediately following the firs gout attack, my left ankle was attacked with migration of attacks then moving to my toes and side opposite of the initial attack on my ankle. Before this combined attack was complete, my right elbow suddenly developed a huge (baseball sized) fluid filled growth. This started two days ago with continual growth until aspirated yesterday. The aspirated fluid was full of Tophi crystals. All of this took place over thirty days use of Uloric. I was then advised by my physician to immediatly stop using Uloric and was perscribed Colchicine to be used alongside Indomethicin to help control the inflamation. I am nearly at my wits end while suffering still from multiple gout flares. I stopped drinking alcohol last November and have stopped consuming shell fish and lowered consumption of purine rich meats. I don’t miss alcohol but sure do miss beef which is now down to once a week. The Uloric regimen was frightening as I had never before suffered from multiple simultaneous attacks. I try to convince myself to embrace the pain in a meditative sense. That doesn’t always work.

    Thought I’d pass all this on. Regards, Rob Ladd

  6. #6 by Linda O'Connor on September 12, 2010 - 12:21 pm

    do you know about the uric acid/glucose meters available in the UK? Would this be a good way to keep your acid levels monitored? Also, do you know any associations between gout and peripheral neuropathy? I have recently started with both and the allopurinol and colchicine make the neuropathy pain worse. Help!

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