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I've had gout for about five years. It's slowly been getting worse. I'm starting to take my own care a little more seriously. The most recent lab tests show my urate level is about a nine. What does that mean?

Gout is caused by sodium urate crystal deposits in the joint. Usually the big toe is affected but other joints can be affected. The exact cause of the accumulation of these crystals isn't clear. It's likely a genetic defect in purine metabolism is the problem.

Urate crystals over the joint surfaces set up an inflammatory response. Joint destruction can occur. By the time a gouty flare-up occurs, microscopic damage has already been done.

Measuring the blood level of urate helps identify the patient's baseline and gives a goal for treatment. Studies show that deposits in the joint rarely clear up when the serum urate level is seven (7 mg/dL) or more.

The goal is to reduce this below six (below five is even better). Levels 10 or higher indicate the gout is getting worse. Urate levels of eight or nine reflect a slower progression of disease.

Lowering serum urate levels can be done with a combination of lifestyle changes and medication. Patients are still advised to reduce calories and alcohol intake. High-sugar fast foods are to be avoided. Finding the right medication and most effective dosage can be a challenge but is a very important part of controlling the disease and its destructive effects.

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