From the FDA Drug Label
The use of colchicine or anti-inflammatory agents may be required to suppress gouty attacks in some cases The mobilization of urates from tissue deposits which cause fluctuations in the serum uric acid levels may be a possible explanation for these episodes Normal serum urate levels are usually achieved in 1 to 3 weeks The upper limit of normal is about 7 mg/dL for men and postmenopausal women and 6 mg/dL for premenopausal women. Too much reliance should not be placed on a single serum uric acid determination since, for technical reasons, estimation of uric acid may be difficult
Checking uric acid levels during an acute gout attack is not necessary.
- The serum uric acid level may fluctuate during an acute attack due to the mobilization of urates from tissue deposits.
- A single serum uric acid determination may not be reliable due to technical difficulties in estimation.
- The management of acute gout attacks usually involves the use of colchicine or anti-inflammatory agents, regardless of the serum uric acid level 1, 1.
From the Research
Checking uric acid levels during an acute gout attack is not necessary and may even be misleading. During an acute flare, uric acid levels can actually be normal or even low, as uric acid crystals have already deposited in the joints, causing inflammation. The diagnosis of an acute gout attack is primarily clinical, based on symptoms like sudden severe joint pain, swelling, redness, and warmth, typically affecting the big toe, ankles, or knees. If diagnostic confirmation is needed, joint fluid analysis to identify monosodium urate crystals is the gold standard 2.
Key Points to Consider
- Uric acid levels are more useful between attacks to guide long-term management decisions about urate-lowering therapy (such as allopurinol 100-800 mg daily or febuxostat 40-80 mg daily) 3.
- Treatment of acute attacks focuses on anti-inflammatory medications like colchicine (1.2 mg followed by 0.6 mg one hour later, then 0.6 mg once or twice daily), NSAIDs (such as naproxen 500 mg twice daily), or corticosteroids, regardless of the serum uric acid level 4.
- Checking uric acid levels is best done 2-4 weeks after an acute attack has resolved when considering initiation or adjustment of urate-lowering therapy 5.
Management of Gout
The management of gout involves treating the acute attack, lowering excess stores of uric acid to prevent flares of gouty arthritis, and providing prophylaxis to prevent acute flares 4. Allopurinol is an effective treatment for reducing concentrations of uric acid, and renal function guides the starting dose of allopurinol, while the baseline serum uric acid concentration guides the maintenance dose 3.
Recent Guidelines
Recent guidelines suggest that urate-lowering therapy can be started during an acute attack, based on the consensus opinion of experts, case studies, or standard of care 6. However, the primary focus during an acute attack should be on managing the symptoms and inflammation, rather than checking uric acid levels. The most recent and highest quality study 6 supports the idea that checking uric acid levels during an acute gout attack is not necessary, and treatment should focus on anti-inflammatory medications and management of symptoms.