Uric acid and gout: here’s a quick rundown on the link between gout and uric acid. Discover what causes gout, its symptoms, diagnosis, and treatment options. But is it curable?
Uric Acid and Gout
When the body’s cells die, certain compounds in the nuclei — called purines — breakdown, producing uric acid as a result. But purines also exist in the cells of the food we eat and, they too, contribute to the total uric acid load.
Gout is a form of inflammatory arthritis caused by higher-than-normal levels of uric acid in the bloodstream. Gout flares occur when needle-like monosodium urate crystals are formed out of the uric acid and deposited in the joints and surrounding tissue.
We all have uric acid in our blood, but normally at healthy levels, e.g., between 4 mg/dL and 6 mg/dL (milligrams per decilitre).
People with gout usually have too-high levels of uric acid in their blood — a condition called hyperuricemia — with levels above 7 mg/dL and even much higher.
The challenge for someone with hyperuricemia is to lower, then maintain uric acid at healthy levels (below 6 mg/dL) in order to reduce the risk of painful gout flare-ups.
What causes hyperuricemia?
Your body needs some uric acid as it’s a powerful antioxidant that helps to neutralize free radicals that damage your cells, proteins and DNA. And, normally, any excess uric acid produced is excreted through urine at a rate that leaves healthy concentrations of uric acid circulating in the bloodstream where it scavenges for those nasty free radicals.
However, there are two scenarios that can lead to overly-high uric acid levels in the blood:
1. The kidneys, for one reason or another, are not processing and excreting enough uric acid quickly enough: This is called under-excretion.
2. The body is producing too much uric acid for the kidneys to process even though they are working efficiently: This is called overproduction.
When either of these happens, excess concentrations of uric acid is retained in the blood, leading to hyperuricemia.
How do patients know when they have hyperuricemia?
Hyperuricemia is usually diagnosed by a blood test which measures uric acid serum concentration.
A doctor will often only carry out a blood test if the patient has other serious conditions such as heart disease, obesity, diabetes, kidney disease, or elevated serum lipids. High uric acid can cause problems with these types of conditions too, so it’s important to know if such patients have hyperuricemia.
However, blood tests aren’t always reliable during an actual gout flare-up since uric acid levels can fall during an attack; although it’s not exactly clear why.
So when someone presents with typical gout symptoms — swelling, inflammation, shiny red skin, warm to touch, stiffness, and excruciating pain — the following tests may also be carried out:
1. Synovial fluid is drawn from the affected joint, using a thin needle, and examined under the microscope for any sign of urate crystals. The synovial fluid test also helps to rule out a bacterial infection as a cause of the symptoms.
2. A CT scan may also be tried, but this is usually for patients who have had multiple gout attacks, and the previous tests have proved unreliable.
Do high uric acid levels always result in gout?
Many people have elevated uric acid levels in their blood but may never get an attack of gout. No one really knows why these people don’t get crystal accumulation in their joints the way other hyperuricemia patients do. It’s estimated that only 1 person in 5 with hyperuricemia will eventually suffer a gout flare-up.
Hyperuricemia is essential to get gout but, just because someone has hyperuricemia, doesn’t necessarily mean they’ll have an attack any time soon. Nevertheless, the higher their uric acid is, the higher their risk of getting gout is, compared to someone with healthy uric acid levels.
How is hyperuricemia treated?
Hyperuricemia is treated using urate-lowering drugs such as allopurinol, febuxostat, and probenecid. Urate-lowering drugs have to be taken daily, and usually for life, since they only work while being taken. Once stopped, uric acid levels may rise again.
But doctors may also advise changing to a low-purine diet to help reduce the amount of uric acid coming in through food. And they may also suggest making some lifestyle changes too, like avoiding / cutting back on alcohol, losing weight, ditching junk food and fizzy drinks, and more.
How often does a gout patient have to have their uric acid levels checked?
A patient being treated with urate-lowering drugs may have a monthly blood test until the correct drug dosage has been confirmed and the uric acid levels are low and stable. Once this has been confirmed, blood tests are probably only needed every one or two years, unless the patient starts to experience flare-ups again.
A hyperuricemia patient, who hasn’t yet had a gout attack, but has any of the medical conditions mentioned previously, may have their levels checked every 6 to 12 months. As the other medical condition is treated, the patient’s uric acid levels may fall or rise as a result of the medication, so this needs to be tracked.
There isn’t a cure for gout, but it can be managed.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, indomethacin, and diclofenac can be effective in reducing the pain and inflammation of a gout attack.
Urate-lowering drugs like allopurinol, febuxostat, and probenecid, can be effective (for most people) in, first lowering, then maintaining uric acid at healthy levels.
Low-purine, low-sugar, diets — fructose can raise uric acid levels too — along with some lifestyle adjustments can also help to manage uric acid levels.
Some people prefer to treat their gout totally naturally, while some patients, who can’t tolerate drug-based medications, may have to look to alternative treatments too.
Many of these alternative remedies and treatments are covered in this website. So please take your time to look around won’t you?