From the Guidelines
Yes, uric acid levels are typically elevated during acute gout attacks, though not always. Serum uric acid (sUA) levels above 6.8 mg/dL create conditions where monosodium urate crystals can form in joints, triggering the intense inflammation characteristic of gout. However, during an acute attack, uric acid levels may actually decrease temporarily as inflammatory processes affect uric acid metabolism. This is why measuring uric acid during an acute attack can sometimes yield misleading results. For diagnostic purposes, it's often better to measure uric acid levels between attacks. The management of gout involves both treating the acute attack with anti-inflammatory medications (such as colchicine, NSAIDs, or corticosteroids) and addressing the underlying hyperuricemia with urate-lowering therapy like allopurinol or febuxostat. These medications should be initiated after the acute attack has resolved, typically aiming for a target uric acid level below 6 mg/dL to prevent future attacks and crystal deposition 1.
Some key points to consider in the management of gout include:
- The use of corticosteroids, NSAIDs, or colchicine to treat acute gout attacks, as recommended by the American College of Physicians 1.
- The importance of measuring uric acid levels between attacks, rather than during an acute attack, for diagnostic purposes.
- The role of urate-lowering therapy in preventing future attacks and crystal deposition, with a target uric acid level below 6 mg/dL 1.
Overall, the management of gout requires a comprehensive approach that addresses both the acute attack and the underlying hyperuricemia. By following the recommendations outlined above and using the most effective treatments available, clinicians can help improve outcomes for patients with gout. It is essential to consider the potential benefits and harms of different treatments, as well as individual patient preferences and values, when making decisions about gout management 1.
From the Research
Uric Acid Levels in Acute Gout
- Uric acid levels can be elevated in gout, but not always, as the disease is caused by the deposition of urate crystals resulting from the overproduction or underexcretion of uric acid 2.
- Acute gout attacks can occur with normal serum uric acid levels, as found in a study where 63.3% of patients with acute gout attack had normal serum uric acid levels 3.
- The diagnosis of acute gout attack should not be excluded in the presence of normal serum uric acid levels if the clinical manifestations or the positive response to colchicine are suggestive of gout 3.
- Uric acid levels are not always a reliable indicator of gout, as other factors such as obesity, alcohol intake, and certain foods and medications can contribute to hyperuricemia 2.
Treatment and Management of Gout
- Treatment goals for gout include termination of the acute attack, prevention of recurrent attacks, and prevention of complications associated with the deposition of urate crystals in tissues 2.
- Pharmacologic management remains the mainstay of treatment, with options including nonsteroidal anti-inflammatory agents, colchicine, and intra-articular injections of corticosteroids for acute attacks 2.
- Urate-lowering therapies, such as allopurinol and febuxostat, aim to prevent gout flares and are used to prevent flare-ups in patients with chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage 4.