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Issue No: HDEH036/17January2013
High Uric Acid and Gout
A high uric acid level, or hyperuricemia, is an excess of uric acid in your blood. Uric acid, also known
as urate, is produced during the breakdown of purine from food (30%) and our cell DNA (70%).
Once produced, uric acid is carried in your blood and passes through your kidneys, where most of it
leaves your body when you urinate.
A high uric acid level may results in attacks of gout, but not everyone who has high uric acid gets gout,
and not everyone with gout has high uric acid.
Gout is classified as either primary or secondary, depending on what causes the high levels of uric acid
in the blood.
• Primary gout
-most likely caused by a combination of genetic, hormonal, and dietary factor
-more than 99% are idiopathic, meaning that the cause cannot be determined
• Secondary gout
-caused by drug therapy or by medical conditions
Statistics
About 90% of people with gout are men
In year 2012, about 1 in 5 (22%) of customer conducted uric acid test in GHHS-HS showed having
high uric acid level
Symptoms as per the stage of the disease
Stage 1: Asymptomatic (without symptoms) hyperuricemia
In this stage, a person has elevated levels of uric acid in the blood but no other symptoms.
Treatment is usually not required.
Stage 2: Acute gout, or acute gouty arthritis
In this stage, hyperuricemia has caused the deposit of uric acid crystals in joint spaces.
This leads to a sudden onset of intense pain and swelling in the joints. The attacks commonly
occur at night and can be triggered by stressful events, alcohol or drugs, or of another illness.
Attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not
occur for months or even years. Over time, however, attacks can last longer and occur more
frequently.
Stage 3: Interval or intercritical gout
This is the period between acute attacks. In this stage, a person does not have any symptoms.
Stage 4: Chronic tophaceous gout
This is the most disabling stage of gout. It usually develops over a long period, such as 10 years.
In this stage, the disease may have caused permanent damage to the affected joints and
sometimes to the kidneys.
With proper treatment, most people with gout do not progress to this advanced stage.
Risk factors and your actions
Rick factors
Your action
Family History
Estimates range from 20 to 80 percent. It is Lifestyle awareness to limit purine intake.
associated with the body's uric acid handling.
Obesity
There is a clear link between body weight and uric Keep your weight within the normal range. But
acid levels. Obese children have a higher risk for avoid fasting or very low-calorie diets because
gout in adulthood.
it increase the amount of uric acid produced by
the body.
Renal (kidney) failure
Some renal diseases reduce the kidneys capability Meet doctor for treatment.
to eliminate body waste including uric acid. Lesser Lifestyle awareness to limit purine intake.
the uric acid eliminated means more accumulation
in the body.
Purine rich diet
Approximately 70% of total body uric acid is
produced by your body, while the remaining 30%
comes from dietary purines.
High-purine foods are such as organ meats, herring,
anchovies, mackerel, red meat (beef, pork and
lamb), fatty fish and seafood (tuna, shrimp, lobster
and scallops).
Limit high purines food intake. Since all meat,
poultry and fish contain purines, if you have
high uric acid, limit the intake to 4 to 6 ounces
(113 to 170 grams) daily.
Low-fat dairy products may lower your risk of
gout. Drinking plenty of water can help your
body get rid of uric acid.
Excessive alcohol
Beer is the kind of alcohol most strongly linked with Limit, especially beer. Beer, which is rich in
gout, followed by spirits. Alcohol increases uric acid purines, appears to be worse than some other
beverages that contain alcohol.
levels in the three ways:
a. Providing an additional dietary source of purines
b. Increasing the body's production of uric acid
c. Reducing kidneys' ability to excrete uric acid
Other influencing factors include gender; being a man, certain medication such as diuretics and aspirin,
lead exposure, organ transplants, cancer treatments and certain illnesses; leukemia, lymphoma,
psoriasis, hypothyroidism and tumor lysis syndrome.
Complications
Uric Acid Nephrolithiasis (Kidney stones)
•
•
It happens 10 - 25% and up to 42 % in primary gout and secondary gout, respectively
Not all of the kidney stones in patients with gout are made of uric acid. Some are made from
calcium oxalate, calcium phosphate, or substances combined with uric acid. Uric acid stones can
also form when you do not have gout or hyperuricemia
Chronic Uric Acid Interstitial Nephropathy
•
•
Crystals slowly form in the structures and tubes that carry fluid from the kidney
Reversible and not likely to injure the kidneys
Kidney Failure
•
•
Sudden overproduction of uric acid can occasionally block the kidneys and cause them to fail
This occurrence is very uncommon but can develop after chemotherapy, severe heat stress from
vigorous exercise, epilepsy and corticosteroid therapy
Source: The Star, Sunday October 3, 2010: Tell Me About, By DR Y.L.M
Ouch! It’s gout
Your big toe’s red, it’s exquisitely painful, and you can’t even touch it. It’s gout.
MY friend has a very painful big toe. He went to the doctor and was told he had gout. Apparently,
his father had it too. What is gout?
Gout is a condition caused by too much uric acid in your body. This causes tiny crystals of urate to form
and deposit in your tissues, thereby causing inflammation, especially your joints.
These uric acid crystals can also become kidney stones and adversely affect kidney function.
Gout has been known as the “king of diseases and the disease of kings”. It is one of the oldest
documented diseases, since the days of the ancient Greeks.
Gout is associated with being obese, rapidly gaining weight (especially when you were young), having high
blood pressure, having high cholesterol, diabetes, and dehydration.
Gout is nine times more common in men than women. If women get it, it’s usually after menopause.
What is uric acid? Why do we have it in our body?
Uric acid is actually the product of the breakdown or metabolism of purines, which are present in our cell
DNA. As our body’s cells die, the chromosomes break down and release purines, which are then converted
to uric acid.
This uric acid is then excreted in the urine and gut. If our kidneys fail to get rid of the excess uric acid, or if
we produce too much uric acid, then we can get hyperuricaemia (high uric acid levels in our blood). In fact,
a disease impairing kidney function is the usual cause of high uric acid, as well as conditions that produce
a lot of cell breakdown, such as leukaemia and other blood disorders.
About 10% of people who have high uric acid levels in their blood are natural overproducers of uric acid.
If you have hyperuricaemia, it is actually considered a precursor to getting gout, even if you have no
symptoms right now.
Purines are also present in the food we eat, such as meats. Some drugs, like thiazides, cause
hyperuricaemia too.
How will I know I have gout?
Arthritis is the most common way gout presents. And the joint that is most affected is the small joint at the
base of your big toe.
A gouty attack is extremely painful. The pain comes on very rapidly, and is quickly followed by inflammation
– manifested by warmth, swelling, tenderness, redness.
In fact, your toe can be so tender that you can’t even put a sock over your foot. You may even have fever.
These gouty attacks can last from several hours to several days, or in the very worst cases, several weeks.
Most people with gout will have repeat attacks.
Other than your big toe, other joints that can be affected are your ankles, knees (note that gout favours
your lower limbs), wrists, fingers and elbows.
You may also have inflammation of your bursae, which are small fluid-filled sacs around your joints. This is
called bursitis. Again, it is caused by uric acid crystal deposits.
Another type of skin manisfestation of gout is called tophi. Here, actual nodular masses of uric acid are
deposited in the soft tissues of your body, most commonly around your fingers, elbow tips, ears, and big
toe. Very rarely, they can be deposited in your vocal cords or even your spinal cord!
Tophi usually appear when there is an extremely high amount of uric acid in your body.
Gouty attacks are precipitated by fever, dehydration, injury to your joint, too much eating, too much alcohol
consumption, and surgery.
Okay, let’s talk about eating. Are there certain types of food I should avoid? I was told that if I eat a
lot of meat, I can get gout. Is this true?
Purine heavy foods include animal organs (for food) such as liver, kidneys, brains. Shellfish like mussels,
prawns, crabs are also very rich in purines. In beverages, alcohol, especially beer and hard liquor, and
corn syrup-based soft drinks are the ones that are most associated with gout.
If you have gout, you should avoid these foods as they can precipitate and increase the frequency of your
attacks.
It is not true that all protein-based foods cause an increased risk of gout. The rest of the protein based
foods and vegetables are perfectly okay when it comes to gout.
If you are overweight, it would help greatly to decrease your weight.
Is there any treatment for gout?
Yes. For acute attacks of gout, there are medicines that reduce the inflammation and alleviate your pain.
But it is more important to prevent such attacks from recurring by reducing your weight, avoiding foods and
beverages that are known to precipitate the attacks and lowering the uric acid in your blood through
medication.
> Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as
medicine, health, computers and entertainment. The information contained in this column is for general
educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness,
functionality, usefulness or other assurances as to such information. The Star and the author disclaim all
responsibility for any losses, damage to property or personal injury suffered directly or indirectly from
reliance on such information.
Source:
1. Anon. (2009) Gout [Online]. U.S.: University of Maryland Medical Center (UMMC). . Retrieved from:
Source:
http://www.umm.edu/patiented/articles/what_symptoms_of_gout_000093_3.htm#ixzz2ICYn9N3q
[Accessed 18th January 2013].
2. Anon. (2012) High uric acid level [Online]. U.S.: Mayo Foundation for Medical Education and Research
(MFMER). . Retrieved from: http://www.mayoclinic.com/health/high-uric-acidlevel/MY00160/DSECTION=causes [Accessed 18th January 2013].
3. Y.Q., J.W.L., J.H.S., F.T., G.R.A., R.J.S., V.B. (2012) Hyperuricemia [Online]. U.S.: Medscape.com.
Retrieved from: http://emedicine.medscape.com/article/241767-overview [Accessed 18th January
2013].
4. Anon. (2009-2010) Gout [Online]. Malaysia: Arthritis Foundation Malaysia. Retrieved from:
http://www.afm.org.my/info/gout.htm [Accessed 18th January 2013].
5. Stanley T.Lewis (2012) Gout will make you shout! [Online]. U.S.: St. Hope. Retrieved from:
http://offeringhope.org/?p=2728 [Accessed 18th January 2013].
6. Dr. R.P (N/A) Why Do I Have It? [Online]. U.S.: Alamo Family Foot and Ankle Care. Retrieved from:
http://podlink.com/treatments-and-conditions/conditions/forefoot/gout.aspx [Accessed 18th January
2013].
7. Anon. (2009) When Gout Treatment Fails [Online]. U.S: Northcoast Footcare. Retrieved from:
http://www.northcoastfootcareblog.com/when-gout-treatment-fails/ [Accessed 19th January 2013].
8. Anon. (2010) Gout - Treatment Overview [Online]. U.S.: WebMD. Retrieved from:
http://arthritis.webmd.com/tc/gout-treatment-overview [Accessed 22nd January 2013].
9. Anon. (2012) Questions and Answers about Gout [Online]. U.S.: National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS). Retrieved from:
http://www.niams.nih.gov/health_info/Gout/default.asp [Accessed 22nd January 2013].