Does hyperuricemia indicate gout?

From the Guidelines

An elevated uric acid level does not definitively indicate gout, though it is a risk factor. Many people with high uric acid (hyperuricemia) never develop gout, while some patients with normal levels can experience gout attacks. Gout is diagnosed based on a combination of clinical symptoms (such as sudden, severe joint pain typically affecting the big toe), physical examination findings, and sometimes joint fluid analysis to identify urate crystals. Hyperuricemia occurs when the body either produces too much uric acid or cannot efficiently eliminate it through the kidneys.

Key Points to Consider

• The most recent and highest quality study 1 emphasizes the importance of searching for risk factors for chronic hyperuricaemia in every person with gout.
• According to the study 1, serum uric acid levels do not confirm or exclude gout, as many people with hyperuricaemia do not develop gout, and during acute attacks serum levels may be normal.
• The study 1 also highlights the importance of lifestyle modifications, such as gradual weight loss in obese patients, to lower SUA levels and reduce the likelihood of gout flare.
• While managing uric acid levels is important for gout treatment with medications like allopurinol or febuxostat, diagnosis requires more than just a blood test.
• If you have elevated uric acid but no symptoms, your doctor may recommend dietary changes (limiting high-purine foods like red meat, seafood, and alcohol) and addressing risk factors like obesity or certain medications rather than starting gout-specific treatments immediately.

Treatment and Management

• Medications like allopurinol (starting at 100mg daily, gradually increasing to 300-600mg daily as needed) or febuxostat (40-80mg daily) may be prescribed to manage uric acid levels.
• Dietary changes, such as limiting high-purine foods and alcohol, and addressing risk factors like obesity or certain medications, may also be recommended.
• Lifestyle modifications, such as gradual weight loss in obese patients, can help lower SUA levels and reduce the likelihood of gout flare.

From the Research

Relationship Between Uric Acid and Gout

• Elevated uric acid levels are associated with an increased risk of gout, as confirmed by several studies 2, 3.
• The risk of gout incidence and recurrence is increased with higher serum uric acid (SUA) levels, demonstrating a graded trend 2.
• Studies have shown that gout incidence rates per 1000 person-years range from 0.8 (SUA ≤ 6 mg/dl) to 70.2 cases (SUA ≥ 10 mg/dl) 2.
• Recurrent gout risk in clinical cohorts ranges from 12% (SUA ≤ 6 mg/dl) to 61% (SUA ≥ 9 mg/dl) among those receiving urate-lowering therapy (ULT) 2.

Uric Acid Levels and Gout Flares

• Higher SUA levels are associated with an increased risk of gout flares in a dose-response manner over 2 years 3.
• The hazard ratios for the risk of gout flares compared with SUA <5.0 are significantly higher for SUA levels ≥6.0 mg/dL 3.
• Time to first flare is shorter for cohorts with higher baseline SUA levels 3.
• Lowering serum uric acid levels can essentially cure gout, but this is not widely practiced 2.

Treatment of Gout

• Urate-lowering therapies aim to prevent gout flares, with an emphasis on treat-to-target strategy; the escalation of therapies until the target serum uric acid is reached 4.
• Standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids, with IL-1 inhibitors newly established as an option for flare refractory to standard therapies 4, 5.
• Allopurinol and febuxostat are initial treatments for urate-lowering therapy, with uricosuric agents as adjuncts 4, 5.