From the Guidelines
Yes, you can have a gout flare even with normal uric acid levels. This occurs because during an acute gout attack, uric acid levels in the blood may actually decrease as urate crystals form in the joints. Blood tests taken during a flare can show normal or even low uric acid levels, which is why doctors often recommend waiting 2-4 weeks after a flare subsides before measuring uric acid for diagnostic purposes. Gout flares happen when urate crystals that have already deposited in joints trigger an inflammatory response, regardless of the current blood uric acid level. This explains why some patients with long-standing gout can experience painful attacks despite having seemingly normal uric acid readings.
Key Points to Consider
- Gout symptoms can occur even with normal uric acid levels, as the inflammatory response is triggered by urate crystals in the joints, not the current blood uric acid level 1.
- Treatment for acute gout flares typically includes anti-inflammatory medications like colchicine, NSAIDs such as naproxen or indomethacin, or corticosteroids to manage the acute inflammation 1.
- Urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and 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 1.
- Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function 1. If you're experiencing gout symptoms like intense joint pain (especially in the big toe), redness, swelling, and warmth, seek medical attention even if previous blood tests showed normal uric acid levels.
Management of Gout
- Education and a non-pharmacological management approach are important in the management of gout 1.
- Lifestyle modifications, such as weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise, can help reduce the risk of gout flares 1.
- A low-fat dairy diet and consumption of coffee and cherries may also be beneficial in reducing the frequency of acute gout 1.
From the Research
Gout Flares with Normal Uric Acid Levels
- Gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within the synovium of joints 2.
- The relationship between serum uric acid levels and gout flares is complex, and flares can occur even with normal uric acid levels 3.
- A study found that fluctuation and change in serum uric acid levels were related to flare occurrence during the first year of urate-lowering therapy, suggesting that fluctuation in serum uric acid is unfavorable during gout treatment 3.
Treatment of Gout Flares
- 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 2.
- Treatment with xanthine oxidase inhibitors or uricosuric drugs is indicated for patients with a recurrent or severe course, with the target uric acid value being <6 mg/dL 4.
- Lifestyle modifications, such as avoiding purine-rich diets and alcohol, can also help prevent gout flares 5, 6.
Uric Acid Levels and Gout Flares
- Asymptomatic hyperuricemia is not an indication for treatment to lower the serum uric acid level in individuals with normal renal function 4.
- However, urate-lowering therapy can help prevent gout flares, and the goal of treatment is to achieve a target serum uric acid level 2, 6.
- Fluctuations in serum uric acid levels, rather than absolute levels, may be more closely related to the occurrence of gout flares 3.