Keith’s GoutPal Story 2020 Forums Please Help My Gout! Uric Acid Rheumatologist wants my target UA to be 3.0

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    Having read several posts here about the controversy of how low should UA target be, I thought some of you may find this useful.   Yesterday, my rheumatologist told me to double my Uloric dose to 80 mg / day because he wants my UA target to be 3.0.  He said normally his target is below 5.0, but in my case, he wants to go lower.  Here's my situation:

    * Was running 9-10 range for at least a year.  Started on Uloric 40 mg (can't take Allopurinol) in January and within 2 weeks, level was 4.5, then 4.9 a month later. 

    * saw some significant improvement over the last couple months with the exception of 2 major flares ups.  When not having flare ups, was able to get rid of the cane and walk almost normally.  Smile

    * However, still had a major flare up in February and another one beginning of March.  each lasted about a week.Frown

    * I had a kidney transplant 15 years ago, so I have reduced ability to excrete UA and I take an immunosuppressant called cyclosporine which also reduces the ability to excrete UA.

    * So, he wants me to target 3.0 because

    1.  Even below 5.0 UA, I have had two major flare ups and

    2.  with my kidney and cyclosporine levels, I need the extra help.

    (Incidently, this is probably not the typical flare ups due to the sudden lowering of UA.  I had no flare ups during the first 2 weeks when my UA went from 9 to 4.5 or for the following 4 weeks).


    He is the expert and it sounds reasonable to me.

    BUT, achieving a 3.0 is not easy without also adding a uricosuric, if even THEN,  which in your case is probably contraindicated.

    Problem is that the lower the SUA the lower the excretion rate of urate…so lowering SUA is sort of self limiting.


    Sounds reasonable. too many Dr's take the “if the SUA is within normal range, it's OK” approach… My SUA is 6.5 and I'm trying to get it as low as possible…

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