From the Guidelines
Uric acid levels should be checked in patients with symptoms of gout, kidney stones, or kidney disease, as well as those with a family history of gout or conditions associated with high uric acid levels.
Key Indications for Uric Acid Level Checks
- Patients with symptoms of gout (joint pain, swelling, redness)
- Those with recurrent kidney stones
- Individuals with chronic kidney disease
- Patients taking medications that can affect uric acid levels (like diuretics, low-dose aspirin, or chemotherapy drugs)
- People with a family history of gout
- Those with conditions associated with high uric acid levels such as obesity, hypertension, diabetes, or metabolic syndrome
Monitoring Uric Acid Levels
Regular monitoring is important for patients already diagnosed with gout or hyperuricemia, typically every 2-6 months when starting urate-lowering therapy like allopurinol or febuxostat, then annually once levels stabilize 1.
Importance of Uric Acid Testing
Uric acid testing helps guide treatment decisions because elevated levels (above 6.8 mg/dL) can lead to crystal formation in joints and tissues, causing painful inflammation 1.
Pre-Test Preparation
Fasting for 8-12 hours before the blood test is recommended for the most accurate results.
Clinical Decision Making
The decision to check uric acid levels should be based on the individual patient's clinical presentation and risk factors, rather than routine screening 1.
From the FDA Drug Label
The minimal effective dosage is 100 to 200 mg daily and the maximal recommended dosage is 800 mg daily 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 but without exceeding the maximal recommended dosage. The correct size and frequency of dosage for maintaining the serum uric acid just within the normal range is best determined by using the serum uric acid level as an index.
Uric acid levels should be checked:
- When starting treatment with allopurinol, to determine the initial dosage
- At weekly intervals, when increasing the dosage of allopurinol, until a serum uric acid level of 6 mg/dL or less is attained
- To maintain the serum uric acid level within the normal range, using the serum uric acid level as an index to determine the correct size and frequency of dosage 2
From the Research
Uric Acid Level Check
Uric acid levels should be checked in various situations, including:
- In patients with chronic kidney disease (CKD), as hyperuricemia is frequently associated with CKD and can accelerate renal decline 3
- In patients with gout, as sustained urate-lowering therapy can impede renal decline 4
- In patients with hypertension, as certain antihypertensive drugs such as diuretics, beta-blockers, and alpha-1 blockers can increase uric acid levels 5
- In patients with hyperuricemia, as febuxostat and allopurinol are recommended as first-line treatments and can lower serum urate levels 6
Specific Conditions
Uric acid levels should be checked in the following specific conditions:
- Hyperuricemia with and without deposition, especially in patients at high renal risk and/or with declining renal function 3
- Gout, as urate-lowering therapy can prevent and delay the decline of renal function 4
- Hypertension, as antihypertensive drugs can affect uric acid metabolism 5
- Cardiovascular disease, as hyperuricemia is associated with an increased risk of cardiovascular disease 7
Monitoring
Uric acid levels should be monitored regularly in patients undergoing urate-lowering therapy, such as febuxostat and allopurinol, to assess the effectiveness of treatment and prevent adverse cardiovascular events 7