I’d always aim lower as quickly as possible. But, I’m happy that your latest question has once again set me off on new research. Actually, it’s updates from Start Allopurinol Quickly, But Carefully, which I mentioned in my recent Gout Gamechangers post. More researchers have agreed that waiting for gout flares to resolve is not usually good for uric acid control. But, they also emphasize the need to manage on a case-by-case basis. So, basically, it’s up to you.
However, I’d like to share my logic. Because, I believe there are benefits from getting well below 300μmol/l uric acid. To explain, the risk comes from partially dissolved crystals. So, if uric acid in the blood is lower, that reduces the time that crystals are partially dissolved. Therefore, it reduces the risk of flares occurring from debulking.
Finally, I’ve often stated there is no lower limit. However the latest guidelines from European rheumatologists suggest that we shouldn’t maintain uric acid below 3mg/dL for long periods. Because, there is some evidence to suggest that:
uric acid might protect against various neurodegenerative diseases such as Parkinson’s disease, Alzheimer’s disease or amyotrophic lateral sclerosis
Of course, that doesn’t mean that we should not consider very low levels to speed the debulking process. But, we have to weigh up all the personal aspects of each individual case. Unfortunately, it’s hard to find doctors who have the time to explain every last detail.