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Dr. Edwards, who co-authored the ACR’s most current guideline, 2012 Guidelines for the Management of Gout, and is a professor of medicine in and vice chair of the Department of Medicine, University of Florida, Gainesville, Fla., says both organizations support a treat-to-target approach and chose 6.0 mg/dL as the target number because multiple clinical trials demonstrated that when a gout patient suppresses their uric acid level to 6.0 mg/dL or below, their main symptoms may decrease in frequency over the first couple of years of treatment with first-line medications until they completely disappear. And if tophi exist, they may also disappear in time. By comparison, when a patient’s uric acid levels remain above 7.0, their disease continues to worsen over time.
So how do physicians advise patients on how to keep their uric acid levels below 6.0?
Some patients think they can treat gout with diet alone, but Dr. Edwards says that is rarely the case. Although he does recommend a Mediterranean diet, with its emphasis on fresh fruits and fish, Dr. Edwards says, “if [patients] know that certain foods trigger their gout flares, such as red meat, shellfish or beer, then they should avoid them. But doing that alone won’t eliminate gout symptoms.”
Dr. Edwards says patients can become compliant by taking a daily uric acid-lowering therapy, primarily allopurinol or febuxostat. In addition, patients should have their uric acid levels checked every one to two months as they adjust to the medication. After a patient’s uric acid level dips below 6.0, they can have their levels checked less frequently—every six to 12 months—to ensure it remains in range.
Throughout a patient’s lifetime, it’s important to check uric acid levels because alterations in an individual’s environment and body can cause uric acid levels to creep upward. For example, certain medications that treat comorbid conditions of gout—such as diuretics for hypertension, low-dose aspirin for coronary artery disease and lipid-lowering agents for high cholesterol—can increase uric acid levels. If a patient loses a significant amount of weight, they may be able to decrease their dosage of a uric acid-lowering therapy.