What Raises Uric Acid?
| Cause | Mechanism |
|---|---|
| High-purine diet | Red meat, organ meats, shellfish, beer → increased urate production |
| Alcohol (especially beer) | Both raises production and reduces renal excretion |
| Fructose / sugary drinks | Metabolised via pathway that increases urate production |
| Diuretics (thiazide, loop) | Reduce renal urate excretion |
| Chronic kidney disease | Reduced urate excretion |
| Rapid cell turnover (leukaemia, chemotherapy) | Massive purine release |
| Obesity | Reduced renal urate excretion; increased production |
Gout Diagnosis
Joint Fluid Is Gold Standard
Joint fluid aspirated from a gouty joint shows negatively birefringent needle-shaped monosodium urate crystals under polarised light microscopy — the definitive diagnosis. Uric acid can be normal during an acute attack.
- Podagra = gout in the big toe joint — the classic presentation
- Attacks are typically sudden, nocturnal, reaching maximum severity within 24 hours
- Attacks last 7–14 days without treatment
- Tophi = chronic crystal deposits in soft tissue — sign of longstanding gout
Uric Acid May Be Normal During an AttackSerum uric acid falls during acute inflammation due to cytokine effects. Do not rule out gout based on a normal uric acid during an acute attack — test 4–6 weeks after resolution.
When should I start allopurinol?
Current guidelines recommend allopurinol for patients with 2+ attacks per year, tophi, urate nephropathy, or kidney stones. Target uric acid <360 μmol/L (or <300 if tophi present). Start at least 2–4 weeks after acute attack resolves.
Does allopurinol cause more gout attacks at first?
Yes — in the first 3–6 months, mobilisation of urate crystals can trigger acute attacks. Co-prescribe colchicine or NSAID prophylaxis during this period.
What foods should I avoid with gout?
Limit: red meat, organ meats (liver, kidney), shellfish (prawns, crab), beer, spirits, and sugary/fructose drinks. Moderate: poultry, fish, vegetables (some high in purines but lower risk). Cherry juice and vitamin C may reduce urate levels.
Can women get gout?
Yes, though less commonly than men (male:female ratio ~4:1). After menopause, oestrogen loss reduces urate excretion, increasing risk. Diuretic use in older women is a common contributor.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.