Should high uric acid bother you?

There is a lack of awareness and many myths related to high uric acid levels in blood. My aim here is to remove common misconceptions related to uric acid and diseases associated with high uric acid. Through this article, I am explaining what needs to be done if you have high uric acid.

What can happen if one has persistent high uric acid?

If a person has persistent high uric acid, one of the following scenarios may develop -

  • Asymptomatic. Persistent high uric acid can remain asymptomatic throughout life without causing any disease or symptoms.
  • Risk of developing gout. Gout is pain and swelling of joints (arthritis) related to high uric acid. This does not mean that everyone with high uric acid has or will develop gout. People with persistent high uric acid are at risk of developing gouty arthritis. Usually first symptom is an acute gout which commonly affects great toe (also known as podagra). There will be severe pain, redness and swelling at the base of the great toe. It can involve different joints in the foot and occasionally ankles and knees. The episode starts with severe pain in great toe base that increases rapidly and then subsides gradually over a week or two. Repeated episodes of gouty arthritis can lead to persistent joint pain, swelling and sometimes deformities known as chronic tophaceous gout
  • Risk of developing kidney stones. Increased urinary uric acid excretion is associated with a higher risk of developing uric acid stones in kidney.
  • Chronic kidney failure. There is an association between high uric acid and chronic kidney disease (CKD) or kidney failure. People with other risk factors like hypertension have more chances of developing kidney failure. A definitive association between high uric acid leading to renal failure has not been firmly established.

Who is more likely to get Gout(uric acid related arthritis)

  • High blood uric acid levels (>7mg/dl)
  • Elderly male
  • Obese
  • Intake of certain medicines like diuretics, TB medicines etc
  • Those with kidney failure or high blood pressure or diabetes

What diet modifications are needed?

There are lot of misconceptions regarding diet restrictions in setting of high uric acid. Red meat, seafood, artificially sweetened juices, soda drinks and excessive alcohol intake should be avoided. Vegetarian sources of proteins like pulses, gram and peas can be safely taken. In short any vegetarian diet can be taken without change. Increasing milk and milk products inthe diet may actually help decrease blood uric acid.Since obesity is a risk factor of having high uric acid so weight reduction will definitely help.

Does high uric acid without symptoms require treatment?

This again is a common myth among people and many doctors too. Asymptomatic high uric acid doesn’t warrant treatment. Lifestyle and diet modifications, weight loss, good control of diabetes and hypertension along with close follow up is the appropriate approach. As per current guidelines starting uric acid lowering therapy is not justified only for high uric acid without any symptoms.

When is treatment required?

  • Frequent acute gout attacks
  • Persistent joint pain or swelling (Chronic gout)
  • Uric aciddeposits in soft tissues (tophi)
  • Gout with renal failure
  • Uric acid kidney stones

What if gouty arthritis is not treated?

In the absence of appropriate treatment and care, over months to years, uric acid crystals get deposited in joints and can cause irreversible damage.

To summarize I would conclude by saying that do not self-medicate with uric acid lowering medicines. Always consult a doctor preferably a rheumatologist, who are trained in treatment of arthritis and related diseases.

Dr. Suvrat Arya
Department of Rheumatology
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