Hyperuricemia - High Uric Acid Levels and Gout

A high concentration of uric acid in the blood, called hyperuricemia, can be associated with arthritic gout as well as other medical conditions, such as hypertension. Many health professionals recommend treating hyperuricemia through diet, lifestyle changes, and/or medication.

This page explains what uric acid is, how hyperuricemia develops, its association with gout and other diseases, and how to lower uric acid levels in the blood.

Uric Acid

The body produces uric acid when it breaks down purines. Purines are organic chemicals naturally found in the cells of humans as well as foods. After the body breaks down purines, uric acid enters the bloodstream.

Uric acid is not necessarily bad—in fact, in certain settings of the body, it can act as an antioxidant. ¹ Stewart DJ, Langlois V, Noone D. Hyperuricemia and Hypertension: Links and Risks. Integr Blood Press Control. 2019;12:43-62. Published 2019 Dec 24. doi:10.2147/IBPC.S184685 ^{, 2} El Ridi R, Tallima H. Physiological functions and pathogenic potential of uric acid: A review. J Adv Res. 2017;8(5):487-493. doi: 10.1016/j.jare.2017.03.003 Most uric acid is processed by the kidneys and excreted in the urine. Some is excreted in the stool.

How Hyperuricemia Develops

It is normal to have a low level of uric acid in the bloodstream. Uric acid levels may get too high when one or more of the following occurs:

• The kidneys are not able to adequately filter and flush out uric acid from the bloodstream
• A person eats foods and beverages that are high in purines
• The body produces too much uric acid

When the body produces too much uric acid, there is typically a genetic cause.

Hyperuricemia and Gout

When hyperuricemia occurs, the excess uric acid can deposit in joints, where it can form uric acid crystals, also called urate crystals. These crystals can cause joint irritation and spur an immune system response that causes joint inflammation. The resulting joint pain, swelling, redness, and warmth are called a gout attack or flare.

Most people who have hyperuricemia do not have gout. In fact:

• Experts estimate that more than 21% of the general population has hyperuricemia while just 4% has gout. ³ Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011;63(10):3136–41. doi: 10.1002/art.30520
• It is possible to have hyperuricemia and uric acid crystals in the joints but experience none of the inflammatory symptoms of gout.

These facts suggest that hyperuricemia may be just one contributing factor to the development of gout. ⁴ Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79. doi:10.1097/BOR.0000000000000679 Researchers are investigating why some people with hyperuricemia develop gout while others do not.

Read more: All About Gout - Symptoms, Diagnosis, Treatment

Hyperuricemia does not lead to pseudogout

Unlike gout, pseudogout is not associated with hyperuricemia. Pseudogout is caused by calcium phosphate crystals and produces symptoms similar to gout.

Read more: All About Pseudogout - Symptoms, Diagnosis, Treatment

Hyperuricemia and Other Medical Conditions

People who have hyperuricemia—whether it is symptomatic or asymptomatic—are more likely to have other medical problems. It is unclear whether hyperuricemia contributes to the development or worsening of these diseases.

Conditions associated with hyperuricemia include but are not limited to:

Chronic kidney disease

When uric acid crystals form, they can collect in the kidney and cause kidney stones. (There are different types of kidney stones; uric acid stones are just one type.) Experts estimate that among people who have gout, nearly 14% report having had kidney stones. ⁵ Kramer HM, Curhan G. The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988-1994. Am J Kidney Dis. 2002 Jul;40(1):37-42. PubMed PMID: 12087559. doi: 10.1053/ajkd.2002.33911

Hypertension (high blood pressure)

High levels of uric acid are known to be associated with high blood pressure. Limited evidence suggests that treating hyperuricemia may prevent or postpone the development of hypertension. ⁴ Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79. doi:10.1097/BOR.0000000000000679

Some blood pressure medications can increase uric acid levels in the blood.

Cardiac disease

Coronary artery disease and congestive heart failure are both associated with hyperuricemia. One study found that about half of patients who were hospitalized or died of heart failure also had hyperuricemia. ⁶ Palazzuoli A, Ruocco G, De Vivo O, Nuti R, McCullough PA. Prevalence of Hyperuricemia in Patients With Acute Heart Failure With Either Reduced or Preserved Ejection Fraction. Am J Cardiol. 2017;120(7):1146-1150. doi:10.1016/j.amjcard.2017.06.057. As cited in Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79. doi:10.1097/BOR.0000000000000679

Some researchers theorize that an enzyme that produces uric acid—not uric acid itself—is associated with coronary artery disease. ⁴ Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79. doi:10.1097/BOR.0000000000000679

Type 2 diabetes

Asymptomatic hyperuricemia is associated with type 2 diabetes. Some researchers theorize that uric acid levels may affect how the pancreas works and worsen insulin resistance. ⁴ Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79. doi:10.1097/BOR.0000000000000679

More research is needed to understand the connection between the above medical conditions and hyperuricemia.

Diagnosing Hyperuricemia

It is possible to measure the amount of uric acid in the blood and urine. Diagnosis typically involves a blood sample, and the measurement is often expressed in milligrams of uric acid per deciliter of blood (mg/dL). A diagnosis of hyperuricemia is considered in ⁷ de Oliveira EP, Burini RC. High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr. 2012;4:12. Published 2012 Apr 4. doi:10.1186/1758-5996-4-12 ^{, 8} Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8-14. doi:10.1016/j.ijcard.2015.08.109 :

• Men who have more than 7.0 mg/dL
• Women who have more than 6.0 mg/dL

It is important to note that uric acid levels in the blood naturally fluctuate, and what is considered "normal" may vary depending on the lab doing the analysis.

Not a routine test

Unlike lab tests for blood cell counts and cholesterol, a lab test to measure uric acid concentrations is not considered routine in North America and Europe. ⁴ Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79. doi:10.1097/BOR.0000000000000679 A doctor will typically only order this test if they have a reason—for example, they suspect a patient has or is at risk of gout.

Asymptomatic hyperuricemia

Signs and symptoms of hyperuricemia are typically associated with urate crystals found in the joints, tendons, or kidneys. ² El Ridi R, Tallima H. Physiological functions and pathogenic potential of uric acid: A review. J Adv Res. 2017;8(5):487-493. doi: 10.1016/j.jare.2017.03.003 People who have abnormally high uric acid levels and no symptoms or signs of urate deposition are said to have asymptomatic hyperuricemia. ⁹ Paul BJ, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene?. Clin Rheumatol. 2017;36(12):2637-2644. doi:10.1007/s10067-017-3851-y

Treating Hyperuricemia

Whether or not to treat hyperuricemia—and how to treat it—typically depends on whether it causes symptoms.

• If hyperuricemia triggers gout attacks, medical treatment is recommended.
  • Immediate treatment to lower uric acid levels can ease the symptoms of an ongoing gout attack.
  • Regular medication and certain lifestyle changes can lower the levels of uric acid in the body, reducing the risk of future gout attacks.
• If hyperuricemia does not cause signs or symptoms (asymptomatic hyperuricemia), the treatment recommendations are less clear.
  • Using uric-acid lowering medications to treat asymptomatic hyperuricemia may have a positive impact on health, but this idea is controversial. ⁴ Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79. doi:10.1097/BOR.0000000000000679 Long-term use of these medications carries potential side effects and health risks. ⁹ Paul BJ, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene?. Clin Rheumatol. 2017;36(12):2637-2644. doi:10.1007/s10067-017-3851-y
  • While the use of medication is controversial, many doctors agree that even asymptomatic hyperuricemia is a sign that lifestyle changes should be made.

Read more about Gout Treatment

Lifestyle changes that can lower hyperuricemia include:

• Eating a whole foods, plant-based diet that is low in purines.
• Losing excess weight through diet and exercise may help lower uric acid levels in the blood. ¹⁰ Ramirez-Sandoval JC, Madero M. Treatment of Hyperuricemia in Chronic Kidney Disease. Contrib Nephrol. 2018;192:135-146. doi:10.1159/000484288
• Getting regular exercise and avoiding a sedentary lifestyle. Research suggests that doing these two things—independent of weight loss—may reduce the risk of hyperuricemia. ¹¹ Yuan S, Zhang ZW, Li ZL. Antacids' side effect hyperuricaemia could be alleviated by long-term aerobic exercise via accelerating ATP turnover rate. Biomed Pharmacother. 2018;99:18-24. doi:10.1016/j.biopha.2018.01.052 ^{, 12} Park DY, Kim YS, Ryu SH, Jin YS. The association between sedentary behavior, physical activity and hyperuricemia. Vasc Health Risk Manag. 2019;15:291-299. Published 2019 Aug 13. doi:10.2147/VHRM.S200278

People who are interested in treating hyperuricemia through diet are advised to learn about purines, which are found in foods and drinks. Experts estimate a low purine diet can reduce uric acid levels up to 15%. ⁹ Paul BJ, Anoopkumar K, Krishnan V. Asymptomatic hyperuricemia: is it time to intervene?. Clin Rheumatol. 2017;36(12):2637-2644. doi:10.1007/s10067-017-3851-y

See Gout Prevention