It is very important for a practitioner to know that hyperuricaemia is rampant in the community, though it may vary according to the social status - a fact which can be confirmed if routine uric acid test is done in a health check up.

If the uric acid level is more than 7.5 mg in a male, then he should be classified as a patient of ‘hyperuricaemia’. In females, the levels are lower by 1-1½ mg. Detecting ‘hyperuricaemia’ in an asymptomatic and otherwise healthy person, is like finding the blood group of a person, but may be a little more significant than that. All patients of hyperuricaemia need not be treated. Uricosuric drugs and allopurinol may create more problems than do any good.

Instead, the following life style changes should be advised:

1. Alcoholics should be advised to reduce alcohol consumption markedly.
2. Those who eat red meat every day should be asked to eat white meat.
3. Those who are overweight, and lead a sedentary life, should be asked to lose weight and go for regular walks.

Any other abnormalities incidentally detected or associated, should be treated e.g. abnormal lipids. If the patient is taking Thiazide diuretics, he should be given alternative diuretics. Even in a patient of gout, who gets only 1-2 attacks per year, the treatment for hyperuricaemia need not be started.

However, the following patients should be given drugs to reduce uric acid levels:

1. Patients, who get frequent attacks of painful gout (painful arthritis)
2. Patients, who have uric acid tophi or deposits in the bursa.
3. Patients, who have uric acid stones.

All secondary hyperuricaemia seen more often in haematological, oncological and nephrological practice, should be treated.

It is also important to remember that the diagnosis of gout is made not by uric acid in the blood but by demonstrating uric acid crystals in the fluid aspirated during the attack of arthritis. This will also exclude other causes of crystal arthritis like calcium pyrophosphate.

Finally, if uric acid is done in 3 laboratories, you will always get 3 different readings. In an otherwise normal person having sober habits, the lowest reading should be taken as the patient’s true reading. During an attack of gout, if “serial estimations” of blood uric acid are done, raised levels will be picked up more often.