How can I lower my uric acid levels?

Effective Strategies to Lower Uric Acid Levels

To effectively lower your uric acid levels, implement a combination of dietary modifications, lifestyle changes, and if necessary, medication therapy targeting a serum uric acid level below 6 mg/dL (360 μmol/L). 1

Dietary Modifications

Foods to Reduce or Avoid

• Alcohol: Especially beer and spirits which significantly increase uric acid production 1, 2
• Sugar-sweetened beverages: Particularly those containing high-fructose corn syrup 1, 3
• Purine-rich foods: Limit intake of red meat, organ meats, and seafood (especially shellfish) 1
• Fructose-rich foods: Moderate consumption of orange and apple juice 1

Foods to Increase

• Low-fat dairy products: Skimmed milk and low-calorie yogurt have an inverse association with urate levels 1, 4
• Coffee: Regular consumption may help lower uric acid levels 4
• Cherries: May reduce the frequency of gout attacks 1
• Vitamin C: Supplementation can help lower uric acid levels 4

Lifestyle Modifications

• Weight management: Weight loss through dietary intervention or bariatric surgery effectively reduces serum uric acid levels 1
• Regular physical activity: Exercise helps decrease mortality associated with hyperuricemia 1
• Hydration: Maintain fluid intake of at least 2 liters daily 5
• Urinary alkalinization: Maintain slightly alkaline urine to prevent stone formation 5

Medication Management

If lifestyle and dietary modifications are insufficient to control uric acid levels, medication therapy may be necessary:

First-Line Therapy

• Allopurinol: Start at 100 mg/day and increase by 100 mg every 2-4 weeks until target uric acid level is reached (below 6 mg/dL) 1, 5
  • For patients with renal impairment, adjust dosing:
    • CrCl 10-20 mL/min: 200 mg/day
    • CrCl <10 mL/min: ≤100 mg/day 5

Alternative Medications

• Febuxostat: For patients who cannot tolerate allopurinol 1, 3
• Uricosuric agents (e.g., probenecid): When xanthine oxidase inhibitors fail or are contraindicated 1, 3
• Combination therapy: Allopurinol with a uricosuric agent when monotherapy fails 1, 3
• Pegloticase: For severe tophaceous gout when other options fail 3

Special Considerations

• Medication adjustments: If taking diuretics, consider substituting with losartan or calcium channel blockers for hypertension; statins or fenofibrate for hyperlipidemia 1
• Target uric acid level: Maintain serum uric acid below 6 mg/dL (360 μmol/L) long-term 1, 6
• Prophylaxis during initial treatment: Anti-inflammatory medications may be needed when starting urate-lowering therapy to prevent flares 3

Monitoring

• Monitor serum uric acid levels every 2-4 weeks during medication dose titration
• Once target is achieved, check levels every 6 months 3
• Maintain lifelong therapy to prevent recurrence of hyperuricemia 1

Common Pitfalls to Avoid

• Underdosing urate-lowering medications
• Discontinuing medications during acute flares
• Failing to adjust allopurinol dose in renal impairment
• Not providing adequate prophylaxis when initiating urate-lowering therapy
• Treating asymptomatic hyperuricemia without other indications 3

By implementing these strategies systematically, you can effectively lower your uric acid levels and reduce the risk of gout attacks and associated complications.