My blood test shows high uric acid — is that gout?

What is the difference?

A raised uric acid is a laboratory finding. Gout is a disease.

For gout, crystals have to collect in the joint and attacks have to occur.

In many people the level stays high for years and no attack ever happens. They do not need treatment.

What does an attack look like?

A gout attack starts suddenly, usually at night or towards morning.

The joint — most often the big toe — becomes red, swollen and too painful to touch.

The pain is so intense that many patients cannot bear even the weight of a blanket.

During an attack the test can mislead

In the middle of an acute attack, blood uric acid can come back normal or even low.

So the conclusion "my test was normal during the attack, therefore it is not gout" is wrong.

Where there is doubt, fluid is drawn from the joint and examined for crystals. That separates gout from pseudogout and from infection.

When does long-term treatment start?

• When attacks recur
• When lumps under the skin — tophi — have formed
• When there are kidney stones or impaired kidney function
• When signs of joint damage appear

In those cases uric-acid-lowering treatment is started and monitored with blood tests. Stopping as soon as the level normalises can bring the attacks back.