From the Guidelines
Elevated uric acid levels of 8.1 mg/dL require immediate attention to prevent further complications, and according to the 2016 updated EULAR evidence-based recommendations for the management of gout 1, urate-lowering therapy (ULT) should be considered and discussed with every patient with a definite diagnosis of gout from the first presentation.
Key Recommendations for Management
- For patients with elevated uric acid levels, such as 8.1 mg/dL, and experiencing foot pain, it is essential to start by managing the acute symptoms and then addressing the underlying cause of elevated uric acid.
- The first step in managing acute gout symptoms, as recommended by the 2016 updated EULAR guidelines 1, includes treating acute flares as early as possible with options such as colchicine, NSAIDs, or oral corticosteroids, considering the patient's medical history and current medications.
- For long-term management, initiating urate-lowering therapy (ULT) is crucial, especially in patients with recurrent flares, tophi, urate arthropathy, and/or renal stones, and those presenting at a young age or with very high SUA levels (>8.0 mg/dL) and/or comorbidities.
Lifestyle Modifications
- In addition to medical treatment, lifestyle modifications play a significant role in managing gout and reducing uric acid levels, including:
- Weight loss if appropriate
- Avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks
- Limiting heavy meals and excessive intake of meat and seafood
- Encouraging low-fat dairy products
- Regular exercise
- These modifications can help reduce the frequency of gout attacks and improve overall quality of life, as supported by the 2016 updated EULAR guidelines 1.
Monitoring and Follow-Up
- It is essential to monitor serum uric acid (SUA) levels and maintain them below 6 mg/dL (360 mmol/L) for most patients, with a lower target for those with severe gout.
- Regular follow-up with a healthcare provider is necessary to adjust treatment as needed and to prevent complications associated with elevated uric acid levels.
From the FDA Drug Label
Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys. The etiology of this hyperuricemia is the overproduction of uric acid in relation to the patient's ability to excrete it If progressive deposition of urates is to be arrested or reversed, it is necessary to reduce the serum uric acid level below the saturation point to suppress urate precipitation. Administration of allopurinol tablets generally results in a fall in both serum and urinary uric acid within 2 to 3 days.
Elevated Uric Acid and Pain in Feet: The patient has elevated uric acid levels (8.1) and is experiencing pain in the feet.
- Diagnosis: The patient's symptoms are consistent with gout, a metabolic disorder characterized by hyperuricemia and deposition of monosodium urate in the tissues, particularly the joints and kidneys.
- Treatment: Allopurinol tablets can be used to reduce serum uric acid levels and alleviate symptoms of gout.
- Effectiveness: Administration of allopurinol tablets generally results in a fall in both serum and urinary uric acid within 2 to 3 days 2.
- Clinical Decision: The patient may benefit from treatment with allopurinol tablets to reduce serum uric acid levels and alleviate pain in the feet. However, it is essential to monitor the patient's response to treatment and adjust the dose as needed to achieve optimal results.
From the Research
Elevated Uric Acid and Foot Pain
- Elevated uric acid levels can cause gout, a common inflammatory arthritis that can lead to severe pain in the feet 3, 4, 5, 6, 7.
- Gout is characterized by the deposition of monosodium urate crystals in joints and tissues, which can cause swelling, pain, and tenderness in peripheral joints or bursae, including the feet 4, 5, 6.
- The management of gout involves the use of non-steroidal anti-inflammatory drugs, colchicine, and corticosteroids to relieve pain and reduce inflammation during acute flares 3, 4, 5, 6, 7.
- Urate-lowering therapies, such as allopurinol and febuxostat, can help prevent gout flares by reducing serum uric acid levels 3, 4, 5, 6, 7.
- Lifestyle modifications, such as dietary changes and weight loss, can also help reduce uric acid levels and prevent gout flares 6.
Treatment Options for Elevated Uric Acid and Foot Pain
- Allopurinol is an effective treatment for reducing uric acid levels and preventing gout flares, but its use requires careful consideration of renal function and baseline serum uric acid concentration 3, 4, 5, 6, 7.
- Febuxostat is another xanthine oxidase inhibitor that can be used to lower uric acid levels, but it has been associated with an increased risk of cardiovascular mortality 4, 5, 6.
- Uricosuric drugs, such as probenecid, can increase uric acid excretion and help reduce serum uric acid levels 3, 5, 7.
- Novel therapies, such as IL-1β antagonists and pegloticase, are also available for the treatment of gout, but their use is typically reserved for patients with refractory disease 5, 6, 7.