What is Hyperuricemia & How is it Treated? | Why Do People Develop Hyperuricemia?

Hyperuricemia is a condition that occurs when there is too much uric acid present in the bloodstream. While hyperuricemia does not cause symptoms most of the time, but it can lead to conditions like kidney stones or gout, which is a painful form of arthritis. ^(1,2,3  High levels of uric acid in the bloodstream are also associated with other health conditions like diabetes and heart disease. The occurrence of hyperuricemia has increased sharply since the 1960s. In fact, the most recent study of hyperuricemia and gout discovered that 43.3 million Americans are afflicted by hyperuricemia. ^(4,5)

The body manufactures uric acid as a byproduct of the process of breaking down purine, which is a chemical found in many foods. The kidneys are responsible for filtering out uric acid from the bloodstream. The condition of hyperuricemia develops when the levels of uric acid get too high to allow your kidneys to continue working properly. ⁽⁶⁾

Over a period of time, hyperuricemia can cause other serious conditions, including kidney stones or gout. While hyperuricemia may not require immediate medical treatment, the conditions it causes do need to be treated at the earliest.

Consuming a diet low in high purine foods can help lower the risk of hyperuricemia progressing into other serious conditions. ⁽⁷⁾

As mentioned above, uric acid is produced when purines are broken down in the body. Purines are chemicals that can be found in certain foods, including:

• Seafood
• Beans
• Red meat
• Organ meat

Usually, your body is able to get rid of uric acid when you pass urine. Hyperuricemia develops when the body is either unable to excrete enough uric acid out through urine or when the body starts producing too much uric acid. This usually happens because the kidneys are not able to eliminate the uric acid quickly enough.

The excess buildup of uric acid levels in the bloodstream can eventually lead to the formation of crystals, usually in and around the kidneys and joints. However, it is possible for these crystals to develop anywhere in the body. The white blood cells in the body, which are part of the body’s immune system, may start attacking these crystals, which causes pain and inflammation. ^(8,9)

Usually, the condition of hyperuricemia does not cause any symptoms, and it is only about one-third of people who actually experience the symptoms of this condition. This is referred to as asymptomatic hyperuricemia. ⁽¹⁰⁾

Even though hyperuricemia is not a disease, but if the condition causes your uric levels to remain high for an extended period of time, then it can lead to other, more serious illnesses. Hyperuricemia causes the build-up of uric acid crystals, which lead to the development of other conditions, including:

Also known as gouty arthritis, gout affects around 20 percent of people with hyperuricemia. ⁽¹¹⁾ People with gout can experience sudden joint pain that tends to worsen over a period of 8 to 12 hours. This sharp pain may decrease after a couple of days but may even continue up to ten days. ⁽¹²⁾ A flare-up episode of gout can return in a matter of weeks, months, or never. An episode of gout can also occur due to a trigger like an illness or injury.

Gout is caused by a rapid fall in the levels of uric acid. Gout can present in the form of flare-ups or isolated attacks. Some people even experience chronic gout, which involves experiencing a number of episodes within a short period of time. ^(13,14)

Gout can impact any joint in the body, but flare-ups usually tend to appear in the large toe first. Ankles, feet, knees, and elbows are usually the most commonly affected parts of the body. Gout attacks also tend to occur suddenly at night. The episodes peak in intensity within 12 to 14 hours, and even if you leave it untreated, gout attacks usually tend to subside by themselves within two weeks. ⁽¹⁵⁾

Some of the common symptoms of gout may include:

• Joint stiffness
• Difficulty moving the affected joints
• Severe pain in the joints
• Misshapen joints
• Swelling and redness

In people who have hyperuricemia for many years, the build-up of uric acid crystals over time can form clumps known as tophi. Tophi are hard lumps that can be found under the skin, in the curve at the top of the ear, and around your joints. The formation of tophi can worsen joint pain and also cause damage to your joints or start compressing your nerves. These usually become visible over a period of time and can start disfiguring the affected part of the body. ^(16,17)

The buildup of uric acid in hyperuricemia can lead to a buildup of stones in the kidneys. Usually, these stones are tiny and can be passed through urine itself. But in some cases, the kidney stones can be too big to pass and may end up blocking certain parts of the urinary tract. ⁽¹⁸⁾

Here are the common symptoms of kidney stones:

• Sharp or stabbing pain in the lower back, abdomen, groin, or side
• Nausea and vomiting
• Difficulty urinating
• Increased urge to urinate
• Difficulty in passing urine
• Foul-smelling urine
• If you have a kidney infection, you may also experience chills or fever.

If the stone blocks the urinary tract, then this buildup of urine can become the perfect breeding zone for bacteria, due to which urinary tract infections are a common side effect when you have kidney stones. ^(19,20)

In the case of kidney stones, the symptoms tend to come on rapidly once the stones develop. However, most stones pass without causing many symptoms.

While anyone can develop hyperuricemia, it is more commonly observed in men rather than women. The risk of hyperuricemia also increases with age. You are also more likely to get hyperuricemia if you are African American or of Pacific Island heritage. ⁽²¹⁾

There are many risk factors closely associated with hyperuricemia, including:

• High blood pressure
• High blood sugar/glucose levels
• Obesity
• Alcohol use
• Exposure to lead
• Exposure to pesticides
• Hypothyroidism
• Kidney disease
• Strenuous exercise or extreme levels of physical activity

Your doctor will prescribe urine and blood tests that will measure your creatinine levels. Creatinine levels will indicate your kidney function and your uric acid levels. Blood will be taken from a vein in your arm, usually on the back of your hand or inside of the elbow. Uric acid can generally be found in your urine when the body excretes it. So your doctor will order a 24-hour urine collection test if high levels of uric acid are found in your blood.

The urine test will also be repeated after you have a diet that does not contain purines. This will help your doctor determine the following:

• Whether your body is producing too much uric acid.
• Where you are consuming too many high-purine-containing foods.
• Whether your body is not able to excrete enough uric acid through urine.

If you have been experiencing the symptoms of gout, your doctor may want to also test any fluid that has accumulated in the joints. This is done by using a thin needle to withdraw fluid from your joint. This fluid is then sent to a laboratory, where it is examined for any evidence of uric acid crystals. The presence of any uric acid crystals will indicate that you have gout. ⁽²²⁾

The treatment for hyperuricemia depends on the underlying cause of the condition. If you have asymptomatic hyperuricemia, then treatment is not recommended. In such situations, there is no proven benefit to administrating any type of uric acid lowering therapies.

However, if your hyperuricemia is happening due to an underlying health condition, then that condition will need to be treated.

There are several medications used to treat gout. These include:

• Febuxostat (brand name Uloric) and allopurinol (brand name Zyloprim) are prescribed to help prevent gout. They work by decreasing the level of uric acid in the blood.
• Colchicine (brand name Colcrys) is used to prevent or treat gout, especially for people who do not tolerate other medications like nonsteroidal anti-inflammatory drugs.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to prevent or lower the severity of gout. These may include naproxen (brand name Naprosyn, Aleve), ibuprofen (brand name Motrin IB, Advil), and celecoxib (brand name Celebrex).
• Probenecid can help reduce the levels of uric acid by preventing gout attacks and increasing urination.

Treatment for tophaceous gout is also the same as the treatment for gout. If the tophi become so big that they start to disrupt your joint movements, damage the surrounding tissues, or start to protrude through the skin, they may have to be removed through surgery.

During this surgical procedure, a surgeon will make an incision in the skin overlying a tophus. The tophus will then be removed. In some rare cases of joint damage, joint replacement surgery might be needed. ^(23,24)

If the size of your kidney stones is smaller than 5 millimeters (mm), your doctor will recommend that you drink a lot of water to make the stone pass through urine and to take over the counter pain relievers until the stone passes.

Kidney stones that are 5 mm or bigger may not pass by themselves. In such cases, some doctors may prescribe medicines like tamsulosin (brand name Flomax) to help relax the muscles of the urinary tract, to make it less painful, and easier to pass the stones. ⁽²⁵⁾

In some rare cases, additional treatment might be required. Extracorporeal shock wave lithotripsy is a non-invasive procedure in which shock waves or ultrasonic energy are directed to your skin at the location of the kidney stone. The shock waves help break down the large kidney stone into smaller pieces that can help it pass more easily through the urinary system. ⁽²⁶⁾

In cases of kidney stones that are bigger than 10 mm, you may need to have them removed through surgery. Ureteroscopic surgery for kidney stones is carried out by passing a 2 mm tube or scope through the urethra. The scope goes through the bladder and directly into the ureters. The ureters are the tubes that connect the kidneys to your bladder. ⁽²⁷⁾

Your doctor will then perform the stone extraction. If the stones need to be fragmented first, stents will be placed to help with the flow of urine. This can help alleviate pain and also keep the ureters dilated to allow for the easier passage of fragmented kidney stones.

Your doctor will also recommend that you make certain dietary changes to help reduce the levels of uric acid in your blood. If you have hyperuricemia due to underlying gout, making these dietary changes will also help lower the risk of gout flare-ups and also slow down the progression of potential joint damage. However, making any dietary changes should not be used as the first line treatment, and you need to still continue following your doctor’s prescribed treatment plan.

Here are certain foods that you should avoid if you have hyperuricemia:

• Red meats
• Organ meat like liver
• Sugary foods and drinks, especially if they are rich in high fructose corn syrup
• Spinach
• Mushrooms
• Peas
• Meat gravies
• Seafood like sardines, scallops, mussels, and anchovies
• Fish like cod, tuna, haddock, and herring
• Lentils and beans
• Beer and alcoholic beverages
• Wheat germ and bran
• Oatmeal
• Yeast supplements

Apart from decreasing the intake of purines, you should also increase your intake of water or other fluids. Being well-hydrated can help reduce gout episodes. You should try to drink at least eight 8-ounce glasses of water or other beverages every day.

Also, exercise regularly and try to maintain a healthy weight.

Having hyperuricemia can increase the risk of developing chronic gout, kidney stones, hypertension, metabolic syndrome, and diabetes. If you have asymptomatic hyperuricemia, making a healthy lifestyle and dietary changes can help reduce the levels of uric acid in the bloodstream. It is important that you follow your doctor’s recommendations to prevent the development of any other serious chronic health conditions due to hyperuricemia.

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