Lower Uric Acid

The rest of this article assumes you have uric acid test results from your healthcare provider. If not, either arrange a test, or consider your own home uric acid monitor.

Why Reduce Uric Acid?

Uric acid normally forms crystals above 6.8mg/dL (.40 mmol/L). There are factors, especially temperature that can alter this point, but it is a good upper limit. Any reading over this limit places you at serious risk of a gout attack. Even if you do not experience such an attack, you will almost certainly suffer slow buildup of urate deposits that will cripple your joints.

How To Lower Uric Acid

Details of different urate lowering treatments are described in the Gout Prevention section. Allopurinol is the most common, but you can discuss other alternatives with your doctor.

Many people opt for lifestyle changes to try and avoid lifelong medications. However, the wise option is to use these medications as short term support until you are satisfied that your lifestyle changes are established and effective. Common lifestyle changes include weight loss and increased exercise. Both these, unless introduced very gradually, can increase uric acid. Therefore it makes sense to use allopurinol, or similar, during your lifestyle adjustments. Once lifestyle changes are effective, you can drop the medications. If the lifestyle changes are not enough, you will have saved months of additional risk from urate deposits.

What Is Your Target Uric Acid Level?

Your long-term target is 6mg/dL (.350 mmol/L). However, during your months or years of untreated gout, you have built up urate deposits in and around your joints. You may even have some deposits, called tophi, under the skin.

You will dissolve these deposits quicker if you reduce uric acid below 6mg/dL until they are gone. 4 or 5 have been common targets. However Hershfield (March 2009 - "Reassessing serum urate targets in the management of refractory gout: can you go too low?") recommends:

maintaining sUA [serum uric acid] near or below 2 mg/dl would probably be safe

Every case needs to be examined individually, both with respect to length and severity of gout history, and previous response to treatment.

Until all urate deposits are dissolved, there is a risk of continuing gout flares. Therefore, it is best in most cases to reduce uric acid as much as possible, in order to dissolve deposits as fast as possible. Hershfield concludes:

Targeting low sUA could improve the elimination of tissue urate stores and achieve better control of [...] gout.

Next Steps For Lowering Uric Acid

Discuss how to lower uric acid in the gout forum, or browse the Gout Prevention section for ways to reduce uric acid.