What is Uric Acid?
As cells die, the body produces chemical products called purines, which the body breaks down further into uric acid that is dissolved in the blood. We urinate most of the acid our body produces.
Some things we eat and drink (especially red meat, organ meats, beer and shellfish) contain high levels of purines, which also become uric acid. After passing through our kidneys, the body breaks those down as well.
What Happens When There is Too Much Uric Acid?
When more uric acid is produced than we need or than the body breaks down naturally, then a high blood uric acid level develops, known as hyperuricemia.
High uric acid levels can develop into crystals when blood uric acid metabolism is poor. When these uric acid crystals (known chemically as monosodium urate crystals) accumulate in and around joints, tissues and kidneys, over time a gout flare or kidney stone can occur.
What is Hyperuricemia?
High levels of uric acid is known as hyperuricemia. It is measured by a uric acid blood test or urine test. When blood uric acid levels are 6.8 mg/dL and above, the stage is set for problems such as gout flares and kidney disease. This is not unlike the way high blood sugars or high cholesterol set the stage for diabetes and heart disease.
The ideal range is between 3.0 mg/dL and 6.0 mg/dL. It’s important to know that not all people with high uric acid levels develop gout or other medical issues, but the more likely those problems will come.
Flares — recognized by a hot, swollen, joint — are so characteristic that most doctors can diagnose gout after observing symptoms of a flare, such as joint inflammation and testing uric acid levels.
Taking fluid from a very swollen joint is sometimes necessary to be certain of the diagnosis. A small sample of the fluid is examined under a microscope, where such placement of crystals can be seen.
This test won’t catch high uric acid levels that are present without a flare, known as asymptomatic hyperuricemia. About 20% of people have asymptomatic hyperuricemia.
How Much Uric Acid is Best?
Maintaining a healthy serum uric acid (sUA) level of 6.0 mg/dL or below is vital to minimizing risk for gout and other serious health issues, such as kidney diseases. There is increasing research into the role high uric acid may play in high blood pressure and heart disease.
In certain advanced cases, an sUA level of 5.0, 4.0 or even 3.0 mg/dL is the best level, after a lab test. As with all medical conditions, those with a high blood uric acid level can work with their physician or healthcare provider to create a treatment plan. Most clinicians will prescribe medications to lower uric acid to the level flares are few or none or to treat the pain of a flare. The lower the uric acid, the less chance of repeat flares.
What are Symptoms of High Uric Acid?
People are usually unaware their uric acid level is high until a gout flare happens. It is not generally measured on routine blood work. High uric acid levels may not be noticed until gout symptoms develop. Symptoms of a gout attack may include extreme joint pain and a swollen joint that is red or hot to touch.
Another symptom of high uric acid can be kidney stones, which cause sharp pain the mid back, the abdomen along with fever, nausea, or vomiting. One in five people with gout will develop kidney stones.
What Else Causes High Uric Acid Levels?
Kidneys that are not filtering well are the leading reason people have too much uric acid in their blood. Genetics play a big role too. People who suffer gout often have a family history of the condition. Having high blood pressure, obesity, and diabetes makes matters worse.
Undergoing chemotherapy treatments for some cancers, most uric acid levels may increase because the cancer treatments increase cell death. Along with this, tumor lysis syndrome may occur. Some medications and inherited diseases may also contribute to the condition.
A uric acid test, measured with a urine or blood sample, is sufficient and can also be used to monitor people undergoing cancer treatment or chemotherapy in addition to testing for gout, checking kidney function after an injury, or diagnosing kidney disorders. Some medications and over-the-counter supplements can affect uric acid testing, so it is important to tell your doctor about anything you are taking.
How a Uric Acid Test Works
The lab can measure in milligrams the amount of uric acid per unit of blood (mg/dL). Before the blood test, your doctor may ask you to fast, but most of the time fasting blood tests for uric acid levels is not necessary.
Once a person is diagnosed with gout it is important to check uric acid levels to be sure whatever treatment is chosen, it is driving down the uric acid level. The lab tests are just a regular blood draw, that is collecting a sample from a vein in the arm.
More than one in three people with gout has not had uric acid levels checked within the past five years. So it is important to make sure a clinician is regularly checking taking blood tests.
Treating Hyperuricemia and Gouty Arthritis
Each person has a unique best treatment and management plan designed for them based on their uric acid levels, their kidney health, and other factors such as the presence of tophi, which are lumps made by uric acid crystals.
Most often, a daily urate-lowering medication is the best way to reduce high levels of uric acid in the blood down to a safe range.
What Medications Help Manage the Condition?
The most widely used urate-lowering medicines are allopurinol and febuxostat (Uloric). In especially stubborn cases, there are a few other options. And for people whose crystals have become large, there is an excellent therapy called pegloticase (Krystexxa). Others known as uricosuric drugs, such as probenecid or lesinurad may be introduced once gout is recurring.
Treating Flares While they’re Happening
To reduce pain from a flare, NSAIDs — such as ibuprofen, naproxen or celecoxib — may be taken at the start of a flare. Colchicine is another common medication used to break a flare. Corticosteroids such as Prednisone can be used as well.
As part of a long-term plan to manage a high uric acid level, sUA-lowering medications and following a healthy lifestyle is important. That includes exercising regularly, staying well hydrated, maintaining a healthy body weight and avoiding a diet high in purines and high-fructose corn syrup.
Health Tips: Purine-Rich Foods to Avoid
These foods should be limited, but not forbidden, as part of a low purine diet that helps prevent gout flares:
- Red meat like beef and lamb
- Pork and organ meats
- Shellfish like shrimp and lobster
- Alcoholic beverages (particularly grain alcohol and beer; wine is ok)
- Fruit juices and sodas sweetened with high-fructose corn syrup
- Sugary cereals and store-bought baked goods
Focus on these Foods Instead
The DASH diet, often recommended for people with high blood pressure, and the Mediterranean diet can be a helpful guide. Drink plenty of water to stay hydrated and help the kidneys flush your bloodstream. Try these foods for a low purine diet:
- Lean proteins like fin fish and chicken
- Low-fat and nondairy products
- Fresh fruits
- Nuts, nut butter, and healthy whole grains
- Vegetables (except dried beans, which may have high purine levels)
A Word of Caution About Diets
Adjusting diet will only lower uric acid levels by about 1.0 mg/dL. The number one factor for developing gouty arthritis is genetics or family history.
In almost all cases, a healthcare provider will prescribe medications to keep levels low and flares at bay.
The best diet advice comes from medical news based in fairly long-term research with strict sourcing guidelines, particularly those from academic research institutions linked to peer reviewed studies and tertiary references.
Spotlight on the Kidney Health Connection
Kidney disease can make treating gout more difficult, so it is best to talk with a doctor, who can give trustworthy health information and provide medical advice.
When uric acid levels are above normal values, crystals formed in the bloodstream can be deposited not only in the joints (causing classic gout flares), but also in the kidneys. These uric acid crystals can form kidney stones, which are usually painful.
Kidney stones can also cause chronic kidney disease, making it even more difficult for the body to expel enough to lower a high uric acid level.
If you have gout or even a family history of the condition, be sure to ask your health care professional for an sUA test every six months, which is best way to manage your level of uric acid within a normal range and help prevent health conditions from worsening.