What is the target serum uric acid level for gout in patients without tophi?

• A. Less than 6 mg/dL
• B. Less than 7 mg/dL
• C. Less than 5 mg/dL
• D. Less than 4 mg/dL

Answer: (A)

The key idea is to keep serum uric acid levels low enough to prevent urate crystal formation and to allow existing crystals to dissolve over time. For most patients with gout who do not have tophi, the target is a serum uric acid level below 6 mg/dL. This threshold aligns with the solubility point of urate in serum under typical conditions, reducing ongoing crystal precipitation and helping reduce flare risk.

In contrast, targeting lower levels (such as below 5 mg/dL or even lower) is generally reserved for patients who have tophi or more severe disease, where promoting crystal dissolution is especially desirable. A level of 7 mg/dL or higher would allow continued crystal deposition and ongoing disease activity, so it’s not the chosen goal for those without tophi.