Uric acid is a component produced by the body as a byproduct of the metabolism of purines which is present in many foods. Purine is also formed in the body by the natural process of breakdown of cell. Uric acid is then carried through the blood, filtered through the kidneys and finally removed from the body via urination.
Normal level of uric acid
Normal values of uric acid in blood differ in male and female.
- For women: 2.5 to 7.5 mg/dl (milligrams/deciliter).
- For men: 4.0 to 8.5 mg/dl.
- Hyperuricemia: It is a condition when there is excess of uric acid present in the blood. It happens in 2 conditions i.e. either the body is producing uric acid in excess or the kidneys are not able to excrete it through urination. Increase in destruction of cells due to cancer or chemotherapy treatments also leads to accumulation of excess of uric acid in body.
- Gout: Gout is a condition where level of uric acid in blood increases. This is a form of painful inflammation of joints also known as inflammatory arthritis, causes swelling of joints especially of the feet and big toes.
- Asymptomatic Hyperuricemia: Hyperuricemia is usually associated with mild or severe symptoms depending on the level of uric acid in blood. But if hyperuricemia is present without any signs or symptoms, this condition is known as asymptomatic hyperuricemia.
- Hypouricemia: It is a condition where uric acid concentration in blood reduced to 2 mg/dl or less. Kidney disease is one of the main causes of this condition, which prevent absorption of uric acid and hence too much uric acid is passed in urine.
- Hyperuricosuria: It is a condition symbolize with presence of excessive amount of uric acid in urine.
- Hypouricosuria: It is a condition where uric acid reduced to an abnormally low level in urine.
Causes of Uric acid
Eating the wrong type of food can be the main reason of increase in the amount of uric acid produced by the body. Many meats are the rich source of purines. However apart from food there are certain medical conditions and genetic tendencies which are responsible for increasing the uric acid level, irrelevant of the fact that you are eating a healthy diet or not. Also few medications and vitamins, reacts with digestive system of the body and affects the metabolism of uric acid. Below are the factors that play a major role in increasing uric acid levels in body:
- Genetics – Inherited form family
- Drinking alcohol especially red wine in large amounts
- Diuretics – Medicines to relieve water retention
- Immuno-suppressing drugs
- Niacin or Vitamin B3
- Leukemia – It is a bone marrow disorder
- Kidney diseases – Such as acute renal failure, where kidneys are not able to eliminate uric acid from body so efficiently
- Kidney stones
- Tumor lysine syndrome – Cells start rapidly increasing into the blood due to certain cancers or as a result of their chemotherapeutic agents.
- Purine rich diet: like liver, meat, sardines, peas, dried beans, mushrooms, anchovies etc.
Symptoms of Uric acid
High uric acid level affects our body on 3 different planes i.e. joints, skin and kidneys. Let’s discuss them in detail:
- Intense pain
- Tenderness while touching
- Discomfort – It remains for long period even after the severe pain subsides
- Limited range of motion
Commonly affected joints: though big toe is the one of the most common area affected but other areas such as ankles, heels, knees, finger, wrist and elbows are equally prone to have these symptoms.
It takes 12 to 24 hours for the pain to increase; afterwards it stays for a few days to weeks
- Lumps are formed underneath the skin, which are known as Tophi.
They usually remain painless but may become swollen or tender during the attacks of gout.
Commonly affected areas: are toes, fingers, wrist and elbows.
Kidney stones – uric acid in kidneys or urinary tract may form kidney stones, which further leads to below symptoms:
- Abdominal pain
- Severe pain in groin area
- High fever with cold chills
- Nausea and vomiting
- Blood in urine
How to Diagnose
Your health care provider may perform below tests to confirm the diagnosis of gout or increased level of uric acid:
- Fluid aspiration Test: Fluid from the affected joint is been aspirated with the help of a needle, which is examined under a microscope. Presence of Urate crystals confirms the diagnosis.
- Blood Test: Blood is analyzed to measure the level of creatinine and uric acid in your blood. It is not a definitive test to confirm the diagnosis. But the doctor may able to make a confirmation based on the high blood levels of uric acid along with your symptoms.
- X-ray Imaging: X-ray of the affected joints can be done to rule out the other causes of inflammation.
- Ultrasound: Ultrasound of musculoskeletal system is done to confirm the presence of urate crystals in affected joint or tophus.
- Dual energy CT scan: It is a new technology with the help of which we can detect urate crystals in a joint, even when they are not undergoing inflammation. But this is not a routinely done test because of its high expenses.
Risks if neglected
Some people though having high level of uric acid in blood never experience the signs and symptoms associated with this condition. Hence recurrent attacks of uric acid remain unnoticed and therefore untreated. If remain untreated for a longer time, it may develop serious health issues, such as:
- Erosion and permanent destruction of a joint
- Tophi – Nodules under the skin
- Heart disease
- Kidney stone
- Kidney failure
- High blood pressure
- Type 2 diabetes
Food to take and avoid
Food to Eat:
- Drink plenty of fluids
- Low fat dairy products
- Fiber rich diet – Such as whole grains, Oats, pumpkin, broccoli and celery should be included in diet.
- Berries – Like strawberry, raspberry, blueberry etc., have anti-inflammatory properties and thus is of great help for the patient having high level of uric acid with inflamed joints.
- Carrot and Cucumber
- Vitamin C – Citrus fruits are the good source of vitamin C, such as kiwi, guava, cabbage, tomato etc.
Food to Avoid:
- Avoid alcohol
- Avoid sugary food and beverages
- Fruit sugar (Fructose)
- Organ meats
- Fish and shellfish
- Dried beans
- Green peas
- Carbohydrates – Such as breads, cakes and cookies etc.
- Stay hydrated
- Exercise regularly
- Limit purine rich food
- Lose weight – Metabolism of fat cells also leads to formation of uric acid in body
- Keep your Insulin level under check
- Reduce stress – Practice yoga and breathing exercise to help get rid of the stress
- Check your medications and supplements
When to see a Doctor
Immediately visit your doctor if you experience any of the below symptoms:
- Intense pain in joint: Presence of pain can be a sign of gout. So any evidence of pain should not be ignored because untreated gout can lead to permanent damage of joint.
- Inflammation of joints with fever: This can be a sign of infection, so seeking medical help is mandatory.
Risk of specific people
Men are more prone to develop high blood level of uric acid than women because women use to have low blood uric acid level in their body. So men are more prone to develop gout in early ages i.e. from 30 to 50.
However after menopause, women develop the same level of uric acid as that of men. And hence women usually develop these symptoms after the age of 50 or we can say after menopause.