Gout and hyperuricemia - higher levels of uric acid make it more difficult to reach 6.0 mg/dL

This page on gout and hyperuricemia (also spelt hyperuricaemia)  was last reviewed or updated on 15 January 2018

In successfully dealing with gout and a high uric acid level (hyperuricemia), much depends on how well gout sufferers remember to take their medicine, whether they drink the required amount of water daily, how they add natural gout remedies and whether they are able to diet successfully. Usually gout and high uric acid co-exist, although a few cases of gout occur at normal uric acid levels.

Other relevant factors include: how healthy they are, and whether they see a rheumatologist. Important health factors include the presence of kidney disease or stones, obesity, the presence of diabetes, high blood pressure, alcohol use, insulin resistance, and many others. The healthier they are, the better.

NB If you're on gout medicines always discuss the addition of natural gout remedies with a doctor. Do not go it alone.

The main treatment idea is to lower uric acid levels to 6.0 mg/dL (0.357 mmol/L) or lower.

Common sense tells us that reaching the 6.0 mg/dL uric acid (UA) level, at which gout crystals often start dissolving, is more likely to happen, and more quickly, if less uric acid has to be removed.

But is common sense about gout and hyperuricemia correct?

In the APEX and FACT trials of febuxostat, both trials with large numbers of study patients, common sense was confirmed. Generally, across all participants, the higher the uric levels, the more difficult it was to reach the target.


To quote from what the European Medicines Agency's report said about this in the APEX study.

"Sub group analysis revealed that the proportion of patients with the last three serum urate (uric acid), (less than) < 6.0 mg/dL, and treatment with febuxostat or allopurinol was dependent on baseline (starting) serum (blood) uric acid concentrations."

In all four medication groups a smaller percentage who started at (greater than) > 10.0 mg/dL (0.594 mmol/L) of uric acid were able to reach (less than) < 6.0 mg/dL after 28 weeks, than those who began at (less than) <9.0 mg/dL (0.535 mmol/L).

Those who were on allopurinol at any of the baseline start levels, performed less well than those on febuxostat, and it was the case too that the higher the starting UA level, the smaller the percentage of participants reaching (less than) < 6.0 mg/dL The allopurinol group performed least well, and not as well as the febuxostat groups at (greater than) > 10.0 mg/dL.

Or, putting it the other way round, there were no exceptions to the rule that the lower the baseline levels, the greater the % of those achieving (less than) < 6.0 mg/dL.

The requirement here was serum uric acid of less than 6.0 mg/dL at each of the last three monthly visits.


In this study, in all of its three tested groups of participants, a smaller % who started at (greater than) > 10.0 mg/dL were able to achieve < 6.0 mg/dL after one year than those who began at (less than) < 9.0 mg/dL The best figures were that 87% and 92% on febuxostat 120 mg, starting at (less than) < 10.0 mg/dL reached the (less than) < 6.0 mg/dL target.

Of those participants who were on allopurinol, all who started at any of the three baselines, performed least well. In fact only 21% starting at (greater than) > 10.0 mg/dL managed to reach (less than) < 6.0 mg/dL whereas for febuxostat at 120 mg it was 65%.

With just one exception, (febuxostat 120 mg daily with a baseline start of 9.0 – 10.0 mg/dL), the trend was that there was more success in reaching (less than) < 6.0 mg/dL when starting baseline figures were usually below the 9.0 mg/dL level.

So what lessons about gout and hyperuricemia can we learn from this?

Hyperuricemia (excess uric acid) is regarded as existing when the blood uric acid levels exceed 7.2 mg/dL, somewhat less in women. Gout and uric acid are inseparable. If you learn than your UA is above this level, the faster you act,  the better are your chances of reducing it to 6.0 mg/dL. And more quickly. Remember too, that uric acid levels have a tendency to rise over time and as you age.

So if you are able to get an annual or six monthly blood test done, ensure it includes serum uric acid. This becomes more important if you are over 50 years old. If you have gout, test more frequently - you can do one at home yourself with a uric acid test meter. Check results with your doctor to ensure you are doing it correctly.

If you think you may get gout and can't get a complete blood test for whatever reason, you might consider only a uric acid test. This is much cheaper than a complete blood test, to whoever, or which organization, ultimately pays for it.

You can read more about febuxostat (Adenuric, Uloric) at this page at the European Medicine Agency's website.

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