What is the serum uric acid level indicative of gout?

From the Guidelines

Uric acid levels should be maintained at <6 mg/dL (360 mmol/L) and <5 mg/dL (300 mmol/L) in those with severe gout to prevent future attacks and complications. For patients with gout, the goal of treatment is to lower uric acid levels to prevent the formation of urate crystals in joints and tissues. According to the 2016 updated EULAR evidence-based recommendations for the management of gout 1, urate-lowering therapy (ULT) should be considered from the first presentation of the disease.

Key Recommendations

• Urate-lowering therapy (ULT) should be considered from the first presentation of the disease
• Serum uric acid (SUA) levels should be maintained at <6 mg/dL (360 mmol/L) and <5 mg/dL (300 mmol/L) in those with severe gout
• Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function
• If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered

Treatment Approach

The treatment approach for gout typically involves a combination of medications and lifestyle modifications. Medications like allopurinol or febuxostat are commonly prescribed to lower uric acid levels. Lifestyle modifications including weight loss, limiting alcohol, avoiding high-purine foods, and staying well-hydrated also help manage uric acid levels. Regular monitoring of uric acid levels is important to ensure treatment effectiveness and adjust medication dosages as needed.

From the FDA Drug Label

The upper limit of normal is about 7 mg/dL for men and postmenopausal women and 6 mg/dL for premenopausal women. To reduce the possibility of flare-up of acute gouty attacks, it is recommended that the patient start with a low dose of allopurinol tablets (100 mg daily) and increase at weekly intervals by 100 mg until a serum uric acid level of 6 mg/dL or less is attained

• Target uric acid level for gout treatment is less than 6 mg/dL 2
• The goal is to achieve a serum uric acid level of 6 mg/dL or less to reduce the possibility of flare-up of acute gouty attacks 2

From the Research

Uric Acid Level for Gout

• The target uric acid level for gout treatment is generally considered to be less than 6 mg/dL, as this is below the saturation point of monosodium urate (MSU) crystals 3, 4, 5.
• Reducing serum uric acid levels to <6 mg/dL can help to inhibit the formation of new MSU crystals and promote the dissolution of existing crystals, thereby reducing the incidence of gout flares and improving disease outcomes 3.
• Some studies suggest that a target serum urate level of <5 mg/dL may be even more effective in preventing gout flares and promoting crystal dissolution 5.
• It is important to note that the optimal target level for serum uric acid concentration in gout management may vary depending on individual patient factors and comorbidities, and further research is needed to determine the best approach 4, 5.

Treatment Considerations

• Treatment of gout typically involves a combination of lifestyle modifications, pharmacological therapies, and regular monitoring of serum uric acid levels 3, 4, 6.
• Medications such as xanthine oxidase inhibitors (e.g. allopurinol, febuxostat), uricosurics (e.g. lesinurad), and anti-inflammatory agents (e.g. NSAIDs, colchicine) may be used to lower serum uric acid levels and manage gout symptoms 7, 4, 6.
• Novel therapies, such as pegloticase and IL-1β antagonists, may also be effective in managing refractory gout or reducing uric acid levels 7, 6.