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Uric Acid and Hyperuricemia

Gout, also known as gouty arthritis, starts with uric acid. The body produces uric acid naturally. As cells die, they release substances called purines, which are also found in some foods. Purines are broken down in the liver and eliminated from the body through the kidneys and intestines.

If the body makes too much uric acid, or if the kidneys are inefficient in getting rid of the excess uric acid, hyperuricemia develops. Hyperuricemia, which is high levels of uric acid in your blood, can lead to gout.

Over time, a sustained high uric acid level increases your risk of gout and you are vulnerable to an acute gout attack. Lowering uric acid to a healthy range – 6.0 mg/dL or below – is the most important step to successfully manage gout and prevent future gout attacks.

The intense pain of a gout attack seems to come out of nowhere when it hits. In reality, the cause of gout attacks comes from uric acid crystals inside your body that build up over time, and then manifest as gout in your affected joint. As the most common form of inflammatory arthritis, gout is a chronic condition that develops over time and persists for a lifetime if untreated.

Before You Can Lower Uric Acid Levels

To accurately measure your risk for gout, your doctor may perform a blood test for uric acid. Gouty arthritis is diagnosed when patients with elevated uric acid levels in their blood present with the classic features of a gout flare, including:

Sudden onset of severe pain in one or two joints
Inability to use the joint during the flare
Extreme tenderness of the affected joint to even the gentlest of touch
The intense pain resolves completely in four to eight days

While an elevated blood uric acid level is essential for the development of gout – not everyone with hyperuricemia has gout. As long as uric acid crystals exist in the body, gout flares are likely. Which is why lowering the uric acid level with medication is crucial to treatment.

medications for gout.

Medications to lower your elevated uric acid levels and lifestyle modification can treat gout by reducing the amount of uric acid in your blood. Otherwise, gout attacks will continue to occur more and more frequently throughout life while more uric acid continues to build in each affected joint.

Urate Crystals Settling in an Affected Joint

Some people with hyperuricemia develop uric acid crystals in and around the joints. These crystals trigger the inflammation that results in the intense joint pain of a gout flare/attack.

The intense pain of a gout attack most often affects the great toe, but other joints, including those of the feet, hands, and ankles can also be involved. These attacks come on suddenly, frequently at night, and the affected joints are warm and tender to the touch. Hyperuricemia can also result in kidney stones forming in 20% to 25% of people with gout.

Who Does Gout Affect?

Men comprise the majority of gout patients. Of the 9.2 million people with gout, approximately 6.1 million are male.

Gout can occur in anyone at almost any age, but gout symptoms most commonly affect men who are 40 years old or older and post-menopausal women.

Others most affected by gout include people with kidney disease. Gout is also strongly linked to obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides) and diabetes.

Because of genetic factors, gout tends to run in families, and are usually associated with an inherited inability of the kidneys to eliminate uric acid from the blood. Gout rarely affects children, but pediatric gout is possible.

WHAT ARE THE RISK FACTORS FOR DEVELOPING GOUT?

The more of the following risk factors (in order of importance) a person has, the greater the risk of developing gout.

Hyperuricemia – A high level of uric acid (above 6.8 mg/dL) is one of the essential gout causes. The higher the serum uric acid level, the more likely it is that you’ll develop gout. The best uric acid level for health is one that’s less than 6.0 mg/dL—regardless of age or gender.
Family History/Genetics – One in four people with gout has a family history of the disease, yet less than half of people with the disease know that it can be hereditary.
Obesity – Only one in 10 Americans knows that obesity can contribute to an increased risk for gout, as well as other related health risks such as kidney stones. Someone with a Body Mass Index (BMI) of 30 or higher is considered obese. Talk to your doctor about maintaining a healthy weight as a part of a long-term gout treatment plan.
Other Health Issues – Gout is associated with other health issues, including high blood pressure, heart disease, diabetes, and chronic kidney disease. It is important to receive a prompt diagnosis and ongoing treatment to manage these conditions.
Diet – Certain foods can raise the level of uric acid in the blood. Chief among these foods high in purines are beer, beef, pork, shellfish, organ meats and foods or beverages sweetened with high-fructose corn syrup. In some people with gout, eating foods in these categories can trigger gouty flares. Removing certain foods from your diet, particularly purine-rich foods, or limiting alcohol intake should only be one part of a broader gout prevention and management plan that includes certain medications to reduce uric acid levels. Be sure that any advice on foods affecting gout is medically reviewed. Learn more about foods high in purines on our Diet & Lifestyle page.

Common Gout Risk Factors

Age – Gout usually begins in men during their 40s through 60s and in women from their 60s through 70s.
Ethnicity – Some ethnic groups are more likely to get gout than others. This is genetic and varies by ethnicity and other health risks. South Pacific Islanders and people from some countries in Southeast Asia have a much higher frequency of gout. In the United States, African Americans have a slightly higher percentage of adults with gout (5%) than Whites or Hispanics (4%).
Gender – Gout affects men more often than women—although, once women are post-menopausal, their rates of developing gout increase to a similar level as men. While gout in the big toe is most common, women are more likely to develop gout in the upper extremities, while men more often develop gout in the lower extremities.
Medications – Use of certain medications—especially diuretics or water pills and low-dose aspirin—can increase uric acid levels in the blood.
Joint Injury – People with joint damage from previous injuries (in the big toe or elsewhere) are more likely at risk of developing gout.

High Uric Acid Levels

Untreated or undertreated gout, where the uric acid is not decreased to less than 6.0 mg/dL, can lead to permanent bone and joint damage and can cause more frequent and severe gout attacks over time. In the first decade of gout symptoms, there are periods lasting several months to 1-2 years when a gout patient has no acute flares or recurring joint pain.

This phase of gout is called “interval” or “intercritical” gout. Although there is no active inflammation during these periods, uric acid crystals continue to form and worsen the overall course of gout.

Find Out More

Learn about gout symptoms, how to relieve pain from gout attacks, and how to get your gout treated best and disease control underway by visiting these pages on our website: