Is hyperuricemia common?
Hyperuricemia occurs when there’s too much uric acid in your blood. High uric acid levels can lead to several diseases, including a painful type of arthritis called gout. Elevated uric acid levels are also associated with health conditions such as heart disease, diabetes, and kidney disease.
Rates of hyperuricemia have risen sharply since 1960. The most recent significant study of hyperuricemia and gout found that 43.3 million Americans have the condition.
Why hyperuricemia occurs
Uric acid is formed when purines break down in your body. Purines are chemicals found in certain foods. This typically includes:
- red meat
- organ meat
Normally, your body rids itself of uric acid when you urinate. Hyperuricemia occurs when your body either makes too much uric acid or is unable to excrete enough of it. It usually happens because your kidneys aren’t eliminating it quickly enough.
Excess uric acid levels in your blood can lead to the formation of crystals. Although these can form anywhere in the body, they tend to form in and around your joints and in your kidneys. Your body’s defensive white blood cells may attack the crystals, causing inflammation and pain.
Only about one-third of people with hyperuricemia experience symptoms. This is known as asymptomatic hyperuricemia.
Although hyperuricemia isn’t a disease, if uric acid levels remain high, over time they can lead to several diseases.
Gout, sometimes called gouty arthritis, occurs in about 20 percent of people with hyperuricemia. A rapid drop in uric acid levels can also trigger gout. Gout can appear as isolated attacks, or flares. Some people experience chronic gout, which involves a number attacks occurring over short periods of time.
Gout can affect any joint in your body, but flares often first appear in your large toe. Feet, ankles, knees, and elbows are also common sites of gout.
Gout attacks tend to occur suddenly, often at night. The attacks peak in intensity in about 12 to 14 hours. Even untreated, attacks of gout usually subside within two weeks.
Symptoms of gout may include:
- severe pain in your joints
- joint stiffness
- difficulty moving affected joints
- redness and swelling
- misshapen joints
If you’ve had hyperuricemia for several years, uric acid crystals can form clumps called tophi. These hard lumps are found under your skin, around your joints, and in the curve at the top of your ear. Tophi can worsen joint pain and over time damage your joints or compress your nerves. They’re often visible to the eye and can become disfiguring.
Uric acid crystals can cause a buildup of stones in your kidneys. Often, the stones are small and are passed in your urine. Sometimes, they can become too large to pass and block parts of your urinary tract.
Symptoms of kidney stones include:
- pain or aching in your lower back, side, abdomen, or groin
- increased urge to urinate
- pain when urinating
- difficulty urinating
- blood in your urine
- foul-smelling urine
If you also have a kidney infection, you may experience fever or chills.
This buildup of urine is an ideal breeding zone for bacteria. As a result, urinary tract infections are common when you have kidney stones.
Who is at risk for hyperuricemia
Several risk factors are associated with hyperuricemia:
- alcohol use
- some medications, particularly medications for heart disease
- lead exposure
- pesticide exposure
- kidney disease
- high blood pressure
- high blood glucose levels
- extreme levels of physical activity
How hyperuricemia is diagnosed
Your doctor may order blood and urine tests to measure creatinine levels, which determines kidney function, as well as uric acid levels.
Blood is usually taken from a vein in your arm, typically on the inside of your elbow or on the back of your hand. Uric acid is normally found in your urine as your body excretes it. Your doctor may order a 24-hour urine collection if elevated levels of uric acid are found in your blood.
This urine test is then repeated after a purine-restricted diet, which helps in determining whether:
- you’re eating too much high-purine foods
- your body is making too much uric acid
- your body isn’t excreting enough uric acid
If you’re experiencing symptoms of gout, your doctor will want to test any fluid that has built up in your joints. This is done by using a fine needle to draw fluid from the joint. It will be sent to a lab where it’ll be examined for any evidence of uric acid crystals. The presence of these crystals indicates gout.
Your treatment for hyperuricemia will depend on its cause. If your hyperuricemia is asymptomatic, treatment isn’t recommended. In this situation, there isn’t any proven benefit to administering uric acid lowering therapies.
If your hyperuricemia is tied to an underlying condition, the condition will need to be treated:
Gout is treated with one or more of the following medications:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can help prevent or reduce the severity of gout. These include ibuprofen (Advil, Motrin IB), naproxen (Aleve, Naprosyn), and celecoxib (Celebrex),
- Colchicine (Colcrys) is often used to prevent or treat gout, particularly for people who don’t tolerate NSAIDs well.
- Probenecid helps lower uric acid levels by increasing urination and is used to help prevent gout attacks.
- Allopurinol (Zyloprim) and febuxostat (Uloric) help prevent gout by reducing the amount of uric acid in your bloodstream.
Treatment for tophaceous gout is the same as for gout. If tophi become so large that they interfere with joint movement, damage surrounding tissue, or protrude through your skin, they may need to be surgically removed.
During this procedure, an incision is made in skin overlying a tophus, and the tophus is removed. In rare instances of joint damage, joint replacement surgery may be considered.
If you have kidney stones smaller than 5 millimeters (mm), your doctor may advise you to drink a lot of water and take over-the-counter pain medications until the stones pass.
Kidney stones that are 5 mm or larger are less likely to pass on their own. Some doctors prescribe medications such as tamsulosin (Flomax) to relax the muscles in your urinary tract. This can make it easier and less painful to pass the stones.
Additional techniques may be required. Extracorporeal show wave lithotripsy is a noninvasive procedure where ultrasonic energy or shock waves are directed through your skin at the kidney stone. The shock waves break the large stone into smaller pieces that can pass more easily through your urinary system.
If the stones are greater than 10 mm, you may need to have them surgically removed.
Ureteroscopic surgery is performed by passing a 2 mm scope through your urethra. It goes through your bladder and directly into the ureters, which are the tubes connecting your kidneys to your bladder.
Your surgeon can then perform stone extraction. If the stones must be fragmented first, stents may be placed to aid the flow of urine. This can help relieve pain and keep the ureters dilated to allow for easier passage of fragmented or dissolving stones.
Certain dietary changes may help decrease the level of uric acid in your blood. If your hyperuricemia is tied to gout, dietary changes may lower your risk of gout attack and slow the progression of any joint damage.
If you think switching up your diet could be beneficial, consult your doctor. They can help you determine if this is the best choice for you.
If you do adjust your diet, you should continue to follow your doctor-recommended treatment regimen. Dietary changes shouldn’t be used as a first-line treatment.
Remember that uric acid is formed when purines break down in your body. Although purine occurs naturally, it’s also present in certain foods. Avoiding these foods may be beneficial.
What to avoid
- red meats
- sugary foods and beverages, especially if they contain high-fructose corn syrup
- organ meat, such as liver
- meat gravies
- some seafood, such as anchovies, sardines, scallops, and mussels
- fish, such as tuna, cod, herring, and haddock
- spinach, peas, and mushrooms
- beans and lentils
- wheat germ and bran
- beer and alcoholic beverages
- yeast supplements
In addition to reducing purines, you should drink more fluids, especially water. Staying hydrated has been tied to fewer gout attacks. A general rule of thumb is to drink eight 8-ounce glasses of liquid each day. Talk with your doctor about how much you should drink.
You should also exercise regularly and maintain a healthy weight. Your doctor can make specific recommendations that best suit your needs.
The bottom line
If you have asymptomatic hyperuricemia, diet and lifestyle changes can help lower uric acid levels in your blood.
If uric acid levels aren’t controlled, you’ll be at risk for developing:
You’ll want to follow your doctor’s instructions to prevent the development of serious chronic medical conditions.