Over 5 years ago leading rheumatologists asked: “Is it time to revise the normal range of serum uric acid levels?”
Of course, they knew then that the answer is “Yes!”
Because they argued the case with clear, indisputable logic. Yet nothing has been done. But at least you now have solid ammunition if a medical professional avoids gout diagnosis. Or refuses uric acid treatment.
I would drop the use of normal altogether. Because it has no clinical relevance in my opinion. But if the medical profession insists on maintaining this outdated reference range it should at least be accurate. So let’s see how the logic of this normal uric acid investigation applies to real-life…
First, we look at what the normal range is.
The actual reference range of serum uric acid has been assessed according to its variations among healthy individuals. i.e. those without clinical evidence of gout. By this approach, serum uric acid values between 3.5 and 7.2 mg/dL in adult males and postmenopausal women and between 2.6 and 6.0 mg/dL in premenopausal women have been identified as normal in many countries.
Infuriatingly for me, this just emphasizes the pointless nature of uric acid reference ranges. Because medically, doctors treat male and female patients the same. So all that the ranges mean is that women are less likely to get gout. But if they’re unlucky enough to get it, the treatment target is just the same as for men.
Silent Uric Acid Crystals Destroy Joints
Next, we see an extremely important viewpoint that is becoming more obvious as diagnostic equipment becomes more sophisticated.
However, […] the absence of gout flares does not necessarily imply the absence of uric acid-related damage. Indeed, a growing body of evidence indicates that silent deposition of monosodium urate crystals as a result of hyperuricaemia may occur and lead to early destructive skeletal changes.
High Uric Acid Levels Destroy Organs
Then the authors remind us that high uric acid levels are associated with heart, kidney, and metabolic disorders. Even where there are no apparent deposits of uric acid crystals.
Asymptomatic Does Not Mean Normal
So they suggest that the medical profession reconsiders the concept of “asymptomatic hyperuricemia”. Because that old concept implies that it’s OK to ignore high uric acid if there are no gout flares. However “silent” crystal deposits destroy joints. And high uric acid (even without measurable crystals) destroys organs. So:
Taken together, these findings strongly suggest to carefully reconsider the concept of “asymptomaticity” for chronic hyperuricemia and to consequently revise the normal range of serum uric acid levels
Act Now! Before This Gets Worse
So they’ve proved that the basis for calculating uric acid reference ranges is wrong. But now the authors warn that this will get worse. Because global trends are for higher average uric acid levels. Therefore they imagine the typical chart of uric acid levels and warn:
the progressive worldwide increase of circulating levels of uric acid, which could lead to a “shift to right” (i.e. toward higher values) of normal range.
Simple Solution to Normal Uric Acid
Gout experts know that they have to get uric acid safe if their patients are to recover. So they treat 6 mg/dL and over as unhealthy. Therefore, the labs should only include results in their calculations if the level is below 6 mg/dL.
In the light of the new scientific knowledge on the pathophysiological role of uric acid in human disease, a threshold value < 6.0 mg/dL (< 360 µmol/L) seems to better identify true "healthy subjects" and should reasonably be considered for all subjects.
Revise Your Normal Uric Acid Range
Now, you understand the failings of currently calculated normal uric acid range. So what you do next depends on your gout status.
Refused Gout Diagnosis With Normal Uric Acid
It’s normal to get gout at the upper end of the current normal uric acid range. So see a rheumatologist if you can’t persuade your doctor to rethink.
Uric Acid Treatment Stopped When Result Becomes Normal
Your treatment target should be low enough to prevent ill health. So insist on targets at least below 6 mg/dL. Though below 5 mg/dL is a better target for many gout patients.
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Revise Normal Uric Acid Range References
- Desideri G, Castaldo G, Lombardi A, Mussap M, Testa A, Pontremoli R, Punzi L, Borghi C. Is it time to revise the normal range of serum uric acid levels. Eur Rev Med Pharmacol Sci. 2014 May 1;18(9):1295-306.