Does elevated uric acid level always lead to gout? (Hyperuricemia does not necessarily cause gout, but all gout patients have hyperuricemia)

Not necessarily. These are two different things, but they are very closely related.

You can understand it this way: our blood is like a glass of water, and uric acid is salt.

High uric acid levels (hyperuricemia) are like having too much salt dissolved in this glass of water, making it a concentrated saltwater solution. At this point, the water is just "salty," but no other problems have arisen. Many people might remain in this "concentrated saltwater" state indefinitely, without experiencing any particular symptoms.

What about gout? Gout occurs when there's so much salt in this concentrated saltwater that the water can no longer dissolve it, causing it to crystallize back into solid salt particles. These "salt particles" (uric acid crystals) deposit in your joints, especially in places like your toes, ankles, and knees, triggering severe redness, swelling, heat, and pain. This process of an attack is what's called gout.

So the conclusion is clear:

1. High uric acid is merely the "prelude" or "soil" for gout. With this soil, the "bitter fruit" of gout might grow, but it's not guaranteed. Many people have high uric acid their entire lives and never experience a gout attack.
2. However, if you have gout, it is definitely caused by high uric acid. Without that "concentrated saltwater" as a foundation, "salt particles" cannot precipitate.

In simple terms, discovering high uric acid during a physical exam is a warning sign, reminding you to start paying attention to your diet and drinking more water, so that the "water" doesn't become "saltier." But there's no need to panic and assume you have gout. Only when your joints actually experience redness, swelling, heat, and pain, is that when gout comes knocking.