Uric Acid Levels Explained: High Uric Acid and Gout

Uric acid is a natural waste product your body makes when it breaks down substances called purines, which are found in your own cells and in food and drink. Most of it is filtered out by the kidneys and leaves the body in urine. When too much builds up in the blood, it can form sharp crystals in and around the joints, which is what causes gout.

This guide explains what a uric acid blood test measures, what a high or low result can mean, the target levels used by doctors in the UK for people with gout, and what you can do to bring a raised level down. It also covers the symptoms that need urgent medical help.

Test it in Chiswick: our Uric Acid blood test costs £39, with your result explained in person by a practitioner. No GP referral needed. Book this test or call 020 4515 0000. Prefer to test at home? A home finger-prick kit is also available, ask us when you enquire.

Quick answer

Many NHS laboratories use an adult reference range of about 200 to 430 micromol/L for men and 140 to 360 micromol/L for women, although ranges vary between laboratories. For people with gout, NICE guidance (NG219) recommends aiming for a uric acid level below 360 micromol/L, and below 300 micromol/L for people with tophi, chronic gouty arthritis or frequent flares despite reaching 360. A level of 360 or more can support a gout diagnosis. A hot, swollen joint with a fever needs urgent same day medical help.

What is uric acid?

Uric acid (also called urate) is made when purines are broken down. Your blood level depends on how much uric acid your body makes and how well your kidneys clear it. Laboratories in the UK usually report it in micromol/L (sometimes written µmol/L or umol/L). You may also see mg/dL on some reports, where 360 micromol/L is roughly 6 mg/dL.

A raised level on its own does not mean you have gout. Gout is diagnosed from your symptoms and an examination, with the blood test as one part of the picture.

What your uric acid result means

Always read the reference range printed on your own report, as each laboratory sets its own. As a guide:

• Low: below the laboratory range. This is less common and is rarely a concern on its own. Your practitioner will look at it alongside your other results.
• Within range: roughly 140 to 360 micromol/L for women and 200 to 430 micromol/L for men at many NHS laboratories.
• At or above 360 micromol/L: above the NICE treatment target for gout, and a level that can support a gout diagnosis if you have typical symptoms.
• Above your laboratory range: worth discussing with a practitioner or GP, especially if you have had joint pain, kidney stones or kidney problems.

Can uric acid be normal during a gout attack?

Yes. Levels can be lower during a flare. NICE advises that if the level is below 360 micromol/L during a flare but gout is still strongly suspected, the test should be repeated at least 2 weeks after the flare has settled.

Gout symptoms

The NHS describes gout as sudden, severe pain in a joint, usually the big toe, with hot, swollen, red skin over the joint. Flares can come back, which is why long-term treatment is sometimes recommended.

What causes high uric acid?

According to the NHS, gout is more likely if you:

• are a man, especially as you get older, or have been through the menopause
• have a family history of gout
• are overweight or drink alcohol
• take medicines such as diuretics (water tablets) or some blood pressure medicines, such as ACE inhibitors
• have high cholesterol, high blood pressure, kidney problems, osteoarthritis or diabetes
• have recently had surgery or an injury

Flares can be triggered by drinking too much alcohol, eating a very large meal, dehydration, an injury to a joint or an illness with a high temperature.

Diet and lifestyle: how to lower uric acid

NICE says there is not enough evidence to show that any specific diet prevents flares or lowers uric acid, so the advice is to follow a healthy, balanced diet rather than a strict one. Your doctor may give you a list of foods to include or limit. NHS advice for people with gout includes:

• avoid lots of sugary drinks and snacks
• try not to drink more than 14 units of alcohol a week, and have some alcohol-free days
• lose weight if you are overweight, but avoid crash diets
• drink plenty of fluids so you do not become dehydrated

Medicines that lower uric acid

If you have frequent or troublesome flares, kidney disease, tophi (lumps of crystals under the skin) or ongoing joint damage, NICE recommends offering urate-lowering treatment such as allopurinol or febuxostat, using a "treat to target" approach. The dose is increased step by step, with a uric acid blood test each month, until the level is below the target. The NHS stresses that these medicines need to be taken regularly, even when you have no symptoms.

When to get urgent help

A hot, swollen, painful joint can also be caused by an infection inside the joint (septic arthritis), which is a medical emergency. Get urgent medical help the same day, by asking for an urgent GP appointment or contacting NHS 111, if you have:

• sudden severe pain and swelling in a joint, together with a high temperature, or you feel hot, cold or shivery
• pain that keeps getting worse, or you cannot move or put weight on the joint
• a painful joint and you feel generally unwell, sick or unable to eat

If you feel very unwell, are confused or are struggling to breathe, call 999 or go to A&E. Do not wait for a private blood test result in any of these situations.

Who should consider a uric acid test?

• People who have had sudden, painful joint attacks, especially in the big toe, foot or ankle
• People already diagnosed with gout who want to check their level against the target
• People with a family history of gout or with kidney stones
• People with high blood pressure, kidney problems or diabetes who want a broader health check

Preparing for your test

You do not usually need to fast for a uric acid test, but we will tell you if a test booked alongside it needs fasting. Drink water as normal. Tell your practitioner about any medicines you take, especially diuretics, blood pressure medicines or urate-lowering treatment, and about any recent gout flare, as this can affect how your result is read.

How often should you retest?

If you are starting urate-lowering treatment, NICE recommends monthly tests while the dose is adjusted. Once you have reached your target, NICE suggests considering a yearly check. If you are not on treatment, ask your GP or practitioner when a repeat test makes sense for you.

Frequently asked questions

Is a uric acid level of 400 high?

For a man, 400 micromol/L may still sit within many laboratory ranges, which go up to about 430. However, it is above the NICE target of 360 micromol/L for people with gout. Whether it matters depends on your symptoms and history, so discuss it with your practitioner or GP.

What is a normal uric acid level for a woman?

Many NHS laboratories use about 140 to 360 micromol/L for adult women. The NHS notes that gout becomes more likely after the menopause.

What uric acid level causes gout?

There is no single level at which gout always starts. NICE uses 360 micromol/L or more as a level that can support a diagnosis in someone with typical symptoms, and as the level to stay below on treatment.

Can you have high uric acid without gout?

Yes. A raised level does not mean you have gout. Gout is diagnosed when there are typical symptoms, and a practitioner can talk through what your result means for you.

Can I lower uric acid without medication?

Keeping to a healthy weight, limiting alcohol and sugary drinks, and staying well hydrated are all recommended by the NHS. People with frequent flares often need medicine as well, and lifestyle changes work alongside it rather than replacing it.

Uric acid testing in Chiswick

We take your blood sample at our clinic at 8 to 9 Bedford Corner, The Avenue, Chiswick, London W4 1LZ, a short walk from Turnham Green station on the District line (Piccadilly line trains stop there early morning and late evening only), and on the 94, E3 and 272 bus routes. Limited parking is available on request when you book. Your sample is analysed at the Randox accredited laboratory, most results are back within a few working days, and a practitioner talks you through what your result means. No GP referral is needed, and we can send a GP feedback report on request.

Book a single Uric Acid blood test, or check uric acid alongside muscle and inflammation markers with our Muscle and Joint Check. You can also compare every blood test and price, read our guide to blood tests for joint pain, or learn more about kidney function test results.

This article is general information, not medical advice. Discuss your results with your GP or practitioner.