Background: Peripheral arterial disease (PAD) is a chronic atherosclerotic progressive disorder that affects the arterial tree especially those of the lower limb which can be screened by the ankle-brachial index (ABI). Generally, uric acid (UA) has been accused of the initiation and progression of atherosclerosis in various arterial segments however, it is a less studied risk factor in PAD. Objective: Our study aimed to evaluate the correlation between increased serum uric acid levels and PAD as indicated by ABI and whether there is a cut-off value for UA to predict PAD. Patients and methods: A case-control study compared 100 patients with PAD as indicated by ABI with 100 cross-matched controls as regards serum UA levels and other risk factors. Moreover, the receiver operating characteristic curve (ROC) was plotted to determine the best cut-off point for UA to detect PAD as indicated by ABI.  Results: The BMI, DM, and dyslipidemia were highly significant among the patient's group (P- value= 0.001). Moreover, UA was significantly correlated to low ABI (P- value=0.003). Besides, UA cut-off value > 6.5 exhibited a specificity of 90% and a positive predictive value of 80% to diagnose PAD. Conclusion: Low ABI was significantly associated with UA denoting its probable relation with lower limb atherosclerosis, with a good positive predictive value to predict it.