High Uric Acid: It’s A Lot More Than Gout Flares

By: Joan McTigue, MS, PA-C When most people think of a gout flare, they picture an older person suffering a red, hot, painful, swollen joint—often of the big toe, ankle, or knee.

The cause of a gout flare is the presence and activity of uric acid crystals in the joints. These crystals result from higher-than-normal uric acid levels (hyperuricemia) in the blood which leads to the formation of uric acid crystals in joints and soft tissues. Unfortunately, too much uric acid in the blood leads to much more than developing crystals and a painful gout flare.

The disease of gout has dramatically increased worldwide over the last few decades. It is no longer a disease of the rich. The easy availability of plentiful food and drink choices, longevity, co-existing diseases like kidney disease, diabetes, high blood pressure, high cholesterol, and obesity are a part of why this happened. Although this is most true in wealthier nations, it is trending worldwide. 

Modern research scientists have come to know there are far more complicated effects of hyperuricemia on the human body than gout flares in the joints. Those are painful enough. But just like with high blood pressure, there are silent but serious effects of hyperuricemia.

In the late 19th century, advances in organic chemistry identified uric acid in the urine. Research scientists quickly confirmed that finding high uric acid in the urine and blood was connected to gout. A direct link between gout and how the kidney functions became solidly identified. Working out just what part of the kidney was involved in filtering uric acid was an important research triumph. Refining that work continues successfully today. 

Once the link between high uric acid and the kidney was firmly established, another question research scientists began to ask was, “What other organs in the human body might be effected by gout and hyperuricemia?”  

It was known from studies of large populations that diseases like alcohol excess, kidney dysfunction, high blood pressure, obesity, and some medications promote hyperuricemia. But scientific researchers began to look at whether hyperuricemia might play a wider role in human health. Perhaps it directly contributes to damage to other organs besides the joints and kidneys?  

Investigators began to focus on seeing if there might be a direct relationship between gout/hyperuricemia and stroke, as well as clogged heart arteries and other blood vessels. Over the past 20 years, hyperuricemia has been shown to be an independent risk factor for high blood pressure, chronic kidney disease, diabetes and cardiovascular disease. Additionally, the risk was more dramatic in women than men. 

In March of 2024, British researchers published a large and important study. Previous research had tied gout and hyperuricemia to stroke, coronary artery disease and blood vessel disease. This group of investigators expanded their work to include a wider variety of heart diseases. They looked at over a dozen heart diseases including pericarditis, heart failure, irregular heart rates, and diseases of heart valves. This study spanned 10 years, looking at more than 800,000 people in the United Kingdom, with and without gout, who had these heart conditions. Overall, it showed patients with gout and hyperuricemia were 58% more likely to develop any one of over a dozen heart diseases than similar persons without gout or hyperuricemia. The connection once again was higher in women.  Having gout and hyperuricemia also amplified the risk for heart disease in persons under 45 years old. 

Is uric acid all bad? Definitely not. At normal levels, it is a strong antioxidant. But, over time, high levels of uric acid turn a good thing into a bad thing for human health.

It has become clearer now that gout and hyperuricemia is firmly connected to several important health issues: The connection to all types of heart disease as well as other serious medical conditions cannot be ignored. 

Good and effective treatments for gout and hyperuricemia now exist. However, to properly treat gout and the associated diseases, those afflicted need access to good health care and must stick to the advice of clinicians and educators. 

We all want to find better therapies and educational ways to help people understand gout/hyperuricemia and its consequences beyond the gout flare. Gout sufferers, scientific researchers, doctors, and other healthcare professionals have good reason for optimism. The research front is exciting. Stay tuned.