I Learned in Medical School that Serum Uric Acid Levels Over 6 mg/dL Increase the Risk of Gout Flares. JAMA Just Published the Same Thing

It’s interesting that old truths get republished just to make sure that we didn’t make the wrong assumption years ago. I found the article itself an interesting. But the editorial in the same issue (2/6/2024) points out why this is an important thing to keep in mind. Because inflammation is at the root of so many diseases beyond once we think of as purely rheumatological, controlling gout is important and often neglected.

Gout is a chronic illness that has been underappreciated and poorly understood. Despite being more prevalent than rheumatoid arthritis and lupus, gout has traditionally lagged behind these other diseases in research and quality of care. In addition, poor clinical management of gout is associated with increased cardiovascular morbidity and mortality, chronic kidney disease, and metabolic syndrome. These associations have been described as forming part of a comorbidity cluster in need of treatment optimization.

Here’s what I wrote about gout a year and a half ago:

Five Plain Truths About Gout

1) Gout is no longer the disease of kings, or even of the affluent. It is hitting harder in lower socioeconomic groups.

2) A low purine diet is no longer a strongly recommended intervention. Cutting back on organ meats and alcohol is. Purine rich vegetables, once viewed as triggers, may be safe because of their fiber content.

3) Uric acid crystals are involved in gout, but it is primarily an inflammatory condition. So not everyone with high uric acid gets gout. This is just like how high cholesterol and low inflammatory markers seems safer than average cholesterol and high inflammatory markers. And, heart attacks and strokes are more likely to happen in the months following a gout attack.

4) Colchicine, one of the treatment options for both acute and chronic gout, works without lowering uric acid levels at all. It treats inflammation, just like the commonly used attack medicine indomethacin and my personal choice, prednisone.

5) Allopurinol, which we use to prevent gout attacks by lowering blood uric acid levels, can also cause them. It should never be started during a gout attack. If attacks happen in the beginning of treatment, I give short prednisone bursts to get patients through the initiation phase.

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