High Uric Acid Level: Causes, Risks, Treatment, Prevention

Introduction

Uric acid is a naturally occurring waste product produced when the body breaks down purine. Purine is a building block of DNA, which may be found in many foods and drinks. While uric acid is typically filtered out of the body by the kidneys and excreted in urine, high levels of uric acid can lead to a variety of health problems. Most people are familiar with the term ’uric acid’ even though there are many facts about this substance that are not well known. In this article, we will explore some of the lesser-known facts about uric acid. It is important for individuals to be aware of their uric acid levels and to work with their healthcare provider to maintain a healthy lifestyle and steer clear of health problems related to uric acid.

Causes of High Uric Acid Levels

Abnormal levels of uric acid can be caused by a variety of factors, including diet, genetics, and certain medical conditions. Mentioned below are the two most common etiologies or the causes of high uric acid levels: overproduction of uric acid and decreased excretion of uric acid.

Uric acid overproduction may be due to the following:

• Purine rich diet which includes fish, shellfish and other seafood
• Error in purine metabolism due to deficiency of enzymes responsible for metabolizing purine
• Diseases characterized by increased cell breakdown like:

• Psoriasis, characterized by dry itchy patches on skin
• Paget’s disease in which both the breakdown and regrowth of bone tissue is increased
• Rhabdomyolysis is characterized by the rapid dissolution of injured skeletal muscle

Decreased uric acid excretion is found in the following situations

• Acute or chronic kidney disease 
• Down syndrome, is a genetic disorder caused due to abnormal cell division
• Hypothyroidism is characterized by a deficiency in thyroid hormone production
• Hyperparathyroidism which is associated with the overproduction of parathyroid hormone
• Sarcoidosis, which is an inflammatory disease
• Hypovolemia, is a state of low fluid volume
• Drugs like ethambutol, pyrazinamide, salicylates, and cyclosporin

Following are the risk factors that cause high uric acid levels:²

• Obesity 
• Hypertension 
• Rheumatoid arthritis

If you have high levels of uric acid, it’s important to talk to your doctor about ways to manage it and reduce the risks that will be discussed in the coming section.

Risks of High Uric Acid Levels

High levels of uric acid (uricemia) in your body can increase the risk of the following conditions:

Gouty arthritis: Deposition of uric acid crystals in the joints causes severe pain, tenderness, and redness in the joint areas. Gouty arthritis is also a risk factor by itself for heart-related diseases.

Renal calculi: High levels of uric acid in the body cause the formation of what we call as kidney stones, which if left untreated can progress to renal failure.

Metabolic syndrome: Uricemia can cause high blood pressure, high blood glucose, abnormal cholesterol levels, and excess body fat together which increases the risk of stroke, diabetes, and heart diseases.

Treatment Options for High Uric Acid Levels

A serum or blood uric acid level below 6.8mg/dL is considered as normal. If your test results show a value higher than this, your doctor will decide the need for medications.¹

Following are the different categories of medicines or uric acid lowering drugs as they are called, which may be prescribed to you to decrease the levels of uric acid: ⁴

• Xanthine oxidase inhibitors: They will decrease the formation of uric acid by inhibiting the xanthine oxidase enzyme, which causes purine to break down into uric acid.
• Uricosurics that increase uric acid removal in urine
• Uricases which are enzymes that convert uric acid into a more soluble form easily removed from the body.

Lifestyle modifications:

• Weight management: Obesity or high body weight increases the risk of uricemia. If you’re obese or overweight, you should try to cut down your excess weight.⁵
• Proper hydration: Drinking a sufficient amount of water and other unsweetened beverages may help dissolve uric acid, making it easier for the body to get rid of excess uric acid.⁵
• Exercises: Low to moderate-intensity exercises like yoga, cycling, and, walking may help lower uric acid levels.⁶

Prevention of High Uric Acid Levels

High uric acid levels in the body can be reduced by the following recommendations:⁴

• Reduce the intake of sweetened beverages
• Avoid alcohol consumption 
• Avoid organ meats and other seafood
• Increase the intake of dairy products 

Conclusion

Uric acid is a waste by-product formed when the body breaks down purine, a component of DNA. Normally, uric acid is filtered out of the body by the kidneys and excreted in the urine, but sometimes, high levels of uric acid can lead to gout, kidney stones, and cardiovascular disease among others. While there are several factors that can contribute to high uric acid levels, lifestyle changes, and medication can help to lower uric acid levels and prevent these conditions from developing. It is important for individuals to be aware of their uric acid levels and take steps to maintain a healthy lifestyle.

Frequently Asked Questions (FAQs)

References:

1. George C, Minter DA. Hyperuricemia. InStatPearls [Internet] 2022 Jul 18. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459218/
2. Li L, Zhang Y, Zeng C. Update on the epidemiology, genetics, and therapeutic options of Hyperuricemia. American Journal of Translational Research. 2020; 12(7):3167. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407685/
3. De Oliveira EP, Burini RC. High plasma uric acid concentration: causes and consequences. Diabetology & metabolic syndrome. 2012 Dec; 4(1):1-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359272/
4. Sattui SE, Gaffo AL. Treatment of Hyperuricemia in gout: current therapeutic options, latest developments and clinical implications. Therapeutic advances in musculoskeletal disease. 2016 Aug; 8(4):145-59. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959626/
5. Líška D. Non-pharmacological treatment of gout. Vnitrni Lekarstvi. 2021 Jan 1; 67(E-2):25-8. Available at: https://europepmc.org/article/med/34074101
6. Hou Y, Ma R, Gao S, Kaudimba KK, Yan H, Liu T, Wang R. The effect of low and moderate exercise on Hyperuricemia: protocol for a randomized controlled study. Frontiers in Endocrinology. 2021:1113. Available at: https://www.frontiersin.org/articles/10.3389/fendo.2021.716802/full

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