uric acid levels in acute gout

Last edited 06/2022 and last reviewed 05/2023

Uric acid levels in acute gout

• serum urate levels should be checked to confirm hyperuricaemia and to monitor response to treatment
  • however, a degree of caution is required in interpreting the results. Serum urate levels tend to decrease during an acute attack of gout and rise again as inflammation settles
  • therefore
    • if the serum urate level is found to be normal during a suspected attack of gout it should be repeated once the attack has resolved
  • NICE state (2):
    • measure the serum urate level in people with symptoms and signs of gout to confirm the clinical diagnosis (serum urate level of 360 micromol/litre [6 mg/dl] or more) (1)
      • if serum urate level is below 360 micromol/litre (6 mg/dl) during a flare and gout is strongly suspected, repeat the serum urate level measurement at least 2 weeks after the flare has settled

Conversely, as most people with hyperuricaemia do not develop gout, concurrent joint symptoms and hyperuricaemia should not be considered to equate with gout unless the clinical presentation is typical or MSU crystals have been identified on aspirated synovial fluid. Renal function should also be assessed.

Reference:

1. Arthritis Research UK (2011). Hands On (9) - gout: presentation and management in primary care
2. NICE (June 2022). Gout: diagnosis and management