What is gout?
Uric acid is a waste product of metabolism, from the breakdown of purines from your own cells and from meat, fish and beer. Two thirds leave the body through the kidneys, a third through the gut, and the vast majority is taken back by the kidneys. If the concentration in the blood rises above what is soluble, crystals can form. If those land in a joint, the immune system responds with a fierce inflammation: the gout attack. How the crystals exactly end up in a joint is largely unknown, but what lifts uric acid is not. It rises with age, in men gradually from puberty and in women faster after the menopause, and further with belly fat and insulin resistance, which make the kidneys excrete less, with alcohol and above all beer, with fructose from soft drinks, with a lot of meat and offal, with diuretics, and with a kidney function that declines. Disposition counts: in about 25% gout runs in the family. During an attack uric acid is raised in about 95% of cases, and a normal value during an inflamed joint makes gout unlikely. Between attacks the joint is quiet, and uric acid meanwhile usually still just as high. Gout often goes together with high blood pressure, in 50%, with cardiovascular disease, about 30%, and with a reduced kidney function, about 25%, because the same belly and the same kidneys sit behind all three.
Which blood values show gout?
Every value below has its own page with the reference ranges of four Dutch labs.
| Value | What it shows | Points here when |
|---|---|---|
| Uric aciddefining | The substance itself. Above 0.35 mmol/L it is called hyperuricaemia, while labs call up to 0.42 normal in men. | high |
| eGFR | Kidney function, and the main reason uric acid climbs: in about 25% of people with gout it sits below 60. | low |
| CRP | Rises with the inflammation during an attack and falls again afterwards. Says nothing about the cause. | high |
| Triglycerides | Raised uric acid often travels with the metabolic syndrome; the fats show that side. | high |
| Fasting glucose | The same side: the sugar handling that often derails together with gout. | high |
What are the symptoms of gout?
These complaints are described for gout in guidelines and research. None of them is exclusive to it: the same complaints fit many other explanations, and an abnormal value can exist without any of them.
A raised uric acid you do not feel. Most people with a raised uric acid never get a gout attack, and between two attacks gout is free of complaints while uric acid usually stays high. A value alone is therefore not a diagnosis, and an attack in a joint other than the big toe is often missed.
- Sudden, severe pain in one joint, which turns red, warm and swollenin the guideline
In 90% of attacks it is one joint with the classic signs of inflammation.
- Inflammation of the base joint of the big toein the guideline
In 50 to 70% of attacks; the NHG calls this podagra.
- Whitish-yellow, firm lumps under the skin, for instance on fingers, toes or the earin the guideline
In 5 to 10%, after longer-standing gout. They are crystal deposits outside the joint, and their presence supports the diagnosis.
A complaint points in more than one direction, and a measurement explains no complaint: blood testing shows where your values stand, the reading and the diagnosis belong with your GP. The complaint list follows the Dutch GP guideline on arthritis (NHG).
What causes gout?
Excretion
The kidneys decide how much uric acid the body loses, and most rises sit on that side.
- Reduced kidney function, in about 25% of people with gout
- Water tablets (diuretics), which slow the removal of uric acid
- Some other blood pressure medicines, such as beta blockers and ACE inhibitors
Production and diet
These links were found in research; the NHG calls a direct causal link insufficiently proven and gives no active advice on them.
- Alcohol, beer in particular
- Fructose-rich soft drinks
- A lot of meat and fish
Predisposition and age
Uric acid rises with the years, and the susceptibility to crystals partly runs in the family.
- Age: gradually from puberty in men, faster after the menopause in women
- Gout in the family, which about 25% of people with proven gout report
What is gout confused with?
Each with the one value that tells the two apart.
Pseudogout (CPPD)
Also a crystal arthritis, but of calcium pyrophosphate, often in knee or wrist and at older age. Uric acid does not separate the two; only joint fluid under the microscope does.
Distinguishing value: Uric acid
Bacterial arthritis
The same fierce inflammation of one joint, but with fever and feeling ill, and an emergency. CRP is high in both; a puncture of the joint decides.
Distinguishing value: CRP
Rheumatoid arthritis
A creeping start, several small joints on both sides. Rheumatoid factor and anti-CCP belong to that picture, uric acid does not.
Distinguishing value: Rheumatoid factor
What you do about gout
Keep uric acid below 0.35 mmol/L, because below that the crystals slowly dissolve again and attacks stay away. Beer is the largest single culprit, followed by spirits and soft drinks with fructose; cut those first. Eat less red meat, offal and shellfish, and more vegetables, legumes, whole grains and low-fat dairy, because dairy products and coffee are linked to a lower uric acid, and drink plenty of water. Anyone with belly fat sees uric acid fall on losing weight, but not with a crash diet, because rapid fasting lifts it temporarily and can trigger an attack. Look at your medicines: diuretics such as hydrochlorothiazide lift uric acid, and often there is a blood pressure medicine that lowers it instead. During an attack rest, cooling and an anti-inflammatory or colchicine help, preferably within a day of the start, and the joint should be tapped once to make the diagnosis certain. After two or more attacks a year, with tophi or with kidney stones allopurinol is the way: it lowers production, is built up slowly and adjusted to uric acid, and keeps the attacks away as long as the number stays below 0.35. Do not measure uric acid during an attack, because then it comes out temporarily lower, but a few weeks after, and then once a year together with kidney function, blood pressure, the fats and glucose, because gout is rarely the only thing at play.
From which uric acid does a lab call it high?
This is what the four largest Dutch labs publish themselves, side by side.
0.15 – 0.34mmol/l
Between 0.12 and 0.15 and between 0.34 and 0.36 it depends on the lab, because each sets its limits on its own method and population. Above 0.36 every lab calls it abnormal.
every lab calls 0.15 – 0.34 mmol/l normal. Between 0.12 and 0.15 and between 0.34 and 0.36 it depends on the lab.
Every age group per lab
| Lab | Group | Reference range |
|---|---|---|
| Unilabs(Saltro, Medlon, SHO, Atalmedial)2026 | Man | 0,20-0,42 mmol/l |
| Vrouw | 0,12-0,34 mmol/l | |
| Star-shl2026 | Vrouw vanaf 18 jaar | 0,12-0,34 mmol/l |
| Man vanaf 18 jaar | 0,20-0,42 mmol/l | |
| Clinical Diagnostics2026 | Man | 0,21-0,43 mmol/l |
| Vrouw | 0,15-0,36 mmol/l |
How to get gout measured
- Fasting
- No fasting needed. Uric acid can be measured at any moment, also outside an attack: in case of doubt the NHG actually has it measured after the attack.
- Material
- Venous blood, drawn at one of our collection points.
- Results
- Results within 24 hours of analysis, in the app.
- Referral
- No referral from a GP required.
- Which test
- The comprehensive test (€229, single test) measures the values on this page.
- Where to draw
- You can draw at 250+ locations near you, no referral needed. See the locations
Frequently asked questions
What are the symptoms of gout?
A gout attack starts suddenly, often within a day: one joint becomes severely painful, red, warm and swollen, so tender that a sheet already hurts. In 50 to 70% that is the base joint of the big toe, but foot, ankle, knee and wrist also occur. After longer-standing gout whitish-yellow lumps can form under the skin, the tophi. Between attacks there is nothing to feel, and precisely then uric acid can be lowered.
What is a uric acid that is too high?
Above 0.35 mmol/L crystals can form, and that is the number treatment works towards; the decision rule for gout hangs on it too. The upper limit on your report is higher: for men 0.42 or 0.43 and for women 0.34 to 0.36, because that band describes what is usual and not what is healthy. So a value of 0.40 is normal on paper and too high for anyone who ever had an attack.
Can you have gout with a normal uric acid?
Rarely. In about 95% of people with a gout attack uric acid is raised, and a normal value with an inflamed joint makes gout unlikely. During an attack the value can come out temporarily lower, because the inflammation makes the kidneys excrete more, and so you measure better a few weeks after the attack. The reverse holds much more often: a high uric acid without ever having gout.
Which foods raise uric acid?
Alcohol, especially beer, soft drinks and fruit juice with fructose, and a lot of red meat, offal and shellfish are linked to a higher uric acid and to gout; dairy products, coffee and cherries to a lower uric acid instead. Vegetables with purines, such as spinach and legumes, do not lift uric acid. The effect of food is modest beside that of belly fat and alcohol, so losing weight and the glass weigh most.
Is gout hereditary?
In part. About 25% of people with proven gout report that it runs in the family, and research points to variants in the transporters with which the kidneys take uric acid back. A specific gene defect can usually not be identified, and disposition alone rarely gives gout: age, kidney function, belly fat, alcohol and diuretics weigh at least as much in practice, and those can be changed.
Sources
- 1.NHG-Standaard Artritis. 2017. richtlijnen.nhg.org
- 2.Richette P et al., 2016 updated EULAR evidence-based recommendations for the management of gout, Annals of the Rheumatic Diseases. 2017. doi.org
- 3.Thuisarts.nl, Ik heb jicht. 2025. thuisarts.nl
This page explains what a result means. It is not a diagnosis and not treatment advice. Discuss complaints or an abnormal value with your doctor.
Read about our scientific approach