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Gout - Management
When should I measure serum uric acid (SUA) in gout?
- Check serum uric acid (SUA) level 4–6 weeks after an acute attack of gout.
- For people on urate lowering therapy, see Follow up for information about monitoring SUA levels.
Clarification / Additional information
- There is no indication for screening for hyperuricaemia in people without symptoms of gout. Asymptomatic people with a raised SUA level do not usually need to be treated with a urate-lowering drug, as gout is not an inevitable consequence of hyperuricaemia. There may be indications for starting a urate-lowering drug in asymptomatic people with malignancy or a very high SUA level (> 800 micromol/L), but this is beyond the scope of this CKS topic [Underwood, 2006a].
Basis for recommendation
These recommendations are based on published expert opinion, pragmatic advice, and a guideline produced by expert representatives of the British Society for Rheumatology (BSR). The evidence supporting the BSR recommendations is based on a systematic review of literature [Jordan et al, 2007].
- Checking the serum uric acid (SUA) level after the first acute attack of gout will help to confirm the diagnosis and may influence the decision to start prophylactic treatment earlier. If a person has a very high level of SUA (e.g. 600 micromol/L or more) they may be more likely to have further attacks.
- A SUA level below 300 micromol/L will not allow urate to crystallize and existing deposits should mobilize. However, even if this target is not reached, any reduction in SUA concentration should reduce the incidence of recurrence [Underwood, 2006a].
- Cohort studies have demonstrated a reduced frequency of subsequent gout attacks in people who achieve a target level of SUA below 360 micromol/L [DynaMed, 2007]. However, some people with even lower SUA levels still have attacks, and attacks may even remit without a reduction in SUA.
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