Uric Acid and Gout: Values, the Attack and Diet
Gout does not begin gradually. It begins at night, in one joint, most often the big toe, and by morning that joint is red, swollen and so tender that even the bed sheet is a problem. Behind it is uric acid that has come out of the blood as crystals. A uric acid test is therefore useful, but it can also mislead: in a good half of people it is normal during the attack itself. This article explains which values are expected, why it is not measured during an attack, what the target value is in someone who has already had gout and what in the diet genuinely moves the number.
Uric acid values
| Who | Usual range | In mg/dL |
|---|---|---|
| Men | 200 to 420 µmol/L | 3.4 to 7.0 |
| Women | 140 to 360 µmol/L | 2.4 to 6.0 |
| Target in diagnosed gout | below 360 µmol/L | below 6.0 |
| Target with tophi and frequent attacks | below 300 µmol/L | below 5.0 |
Why it is not measured during an attack
During an acute attack uric acid often falls, because it is precisely then being deposited in the joint. A normal result at that moment does not rule gout out, and a raised one does not prove it. That is why, where possible, it is measured two to four weeks after the attack has settled. The diagnosis is confirmed by finding crystals in fluid drawn from the joint; in practice it is often made from the clinical picture, because an attack is recognizable.
Raised uric acid with no symptoms
Most people with a raised result will never get gout. A raised value on its own, with no attack and no kidney stone, is as a rule not treated with medication; it is monitored while the reason is looked for: excess weight, alcohol, diuretics, kidney function, psoriasis, and rarely blood disorders. The decision to treat is made when there is an attack, a tophus or a stone, not because of the number itself.
What in the diet genuinely moves the number
Diet on its own lowers uric acid modestly, by around 10 to 15 %, and does not replace treatment when treatment is needed. Even so, three things have the clearest effect:
- Beer and spirits: the strongest single trigger of an attack. Beer is worse than wine, because it brings both purines and alcohol.
- Fructose: fizzy drinks and juices with added sugar raise uric acid faster than most foods.
- Offal, seafood and sardines: the richest in purines. Red meat in moderate amounts is a smaller problem than the above.
On the other side, lower-fat dairy products, coffee and enough fluid all favor a lower result. Vegetables rich in purines, such as spinach and peas, do not cause attacks in practice and are not cut out.
What is done during an attack
An attack is treated as early as possible, because the medicine works better the sooner it is taken. The treatment is decided by a doctor according to kidney function and the other medicines the person is taking. A medicine that lowers uric acid is not started abruptly during an attack, and if it is already being taken it is not stopped. The joint is rested and cooled; heat makes it worse.
What is monitored alongside uric acid
Gout rarely comes alone. Alongside it, kidney function (creatinine and clearance), blood sugar, lipids and blood pressure are looked at as a rule, because they often appear together with raised uric acid. With recurrent attacks, whether tophi are present and whether there has been a kidney stone are also followed.
What the appointment looks like
Bring the uric acid result with its reference range, the kidney function results and a list of your medicines, especially diuretics. A rheumatologist or an internist examines the joint, reads the results together and says whether this is gout, how urgent it is and whether treatment to lower uric acid is needed or monitoring is enough. No referral is needed for an appointment with us.
Prices
| Service | Price |
|---|---|
| Rheumatology appointment (Dr Marko Vorkapić) | 6.000 RSD |
| Internal medicine appointment (Dr Andreja Kovačević) | 6.000 RSD |
| Appointment + ultrasound of the joint/tendons | 10.000 RSD |
Frequently asked questions
What is a normal uric acid value?
In men roughly 200 to 420 µmol/L, in women 140 to 360 µmol/L. If gout has already been diagnosed, the target is below 360 µmol/L, and with tophi below 300 µmol/L.
Can you have gout with a normal result?
You can, and it is a common trap. During an attack the uric acid is being deposited in the joint and the blood result can come out normal. That is why it is measured two to four weeks after the attack has settled.
What should you not eat with gout?
The biggest effect comes from cutting out beer and spirits and fizzy drinks with fructose, and only then from reducing offal, sardines and seafood. Vegetables rich in purines are not cut out.
Is raised uric acid without an attack treated?
As a rule not with medication. The reason is looked for and weight, blood pressure, blood sugar and kidney function are monitored. Treatment is started when there are attacks, tophi or a kidney stone.
Which joint hurts most often?
The big toe, in more than half of first attacks. Next come the ankle, the knee and the small joints of the foot. An attack is almost always in one joint and is at its worst in the first 24 hours.
Book an appointment
If you have had an attack or your uric acid is raised, book an appointment with a rheumatologist or an internist at the Miren Medic clinic. The result, the examination of the joint and a monitoring plan come from one place, without a referral.
