Uric Acid and Joint Problems

There is lack of awareness and many wrong concepts regarding uric acid and joint problems. This article is looking forward to increase awareness regarding this topic in general public and doctors.

What joint problems uric acid can cause?

The only joint problem related to high blood uric acid level is "Gout"

Symptoms of Gout are episodes of severe pain, redness and swelling at the base of great toe (Image). It can involve different joints in foot and occasionally ankles and knees. The episode starts with severe pain in great toe base that increases rapidly within first 12-hours to maximum intensity. Pain and swelling than subsides gradually over a week or two, leaving behind almost normal joint.

In addition to joint problems, high uric acid has been related to kidney stones and high blood pressure.

You are more likely to get Gout if

• You have high uric acid levels (>7mg/dl)
• Are male
• Are an older adult
• Are obese
• You are taking certain medicines to increase urine output
• Eat certain foods, like red meat and organ meat (liver)
• Drink alcohol and sugary drinks, like soda sugar-sweetened juice
• Have certain health conditions, like kidney failure, high blood pressure, and diabetes
• Have had a kidney transplant

What joint problems are not due to high uric acid?

Uric acid related joint problems are not seen in young women and does not cause mild joint pain. Uric acid cannot lead to continuous joint pain and swelling for months (>45 days). Mild pain at the base with gradual outward deviation of great toe over months to years is not due to high uric acid. Uric acid does not cause whole body pain. Uric acid also does not lead to lower back-pain.

How is gout diagnosed?

Your doctor will diagnose gout based on your symptoms mentioned above and examination of joints. He may require X-rays, ultrasound and sometime joint fluid aspiration to confirm the diagnosis. Blood uric acid level is not necessary to diagnose Gout.

How is gout treated?

Treatment has two parts. It starts with rest, ice-pack application and use of painkillers to control the pain and swelling of the joint involved. Later in some patients medicines to decrease blood uric acid level below <6mg/dl are required. This medicines to lower uric acid levels once started needs to be taken regularly and will prevent further episodes of joint pain. Lifestyle changes like weight reduction, avoiding alcohol, taking water enough to avoid dehydrations also help to control gout.

Do you need treatment for all high uric acid levels (>7 mg/dl)?

No, there is no need to treat high uric acid levels that is not causing above joint problem or kidney stones.

Treatment of high uric acid is required only in patients with

• Repeated attacks of Gout (described above)
• Patients with long duration kidney diseases
• Those who have repeated kidney stones with high blood uric acid

What diet precautions I should take if I have Gout?

There is a wrong concept among doctors and public, that Gout patients should not take vegetarian protein diet for example pulses and whole grains. Uric acid and arthritis has nothing to do with high protein diet. Uric acid is the end product of purine metabolism and not protein.

Diet to be avoided by patients with high uric acid and gout are

Non-vegetarian diet for example red meat, liver and kidney, artificially sweetened soda drinks and excessive alcohol intake. Most of the western literature recommends taking more of vegetarian sources of proteins, as they are low in purine. Increasing milk and milk products in diet decreases blood uric acid.

What if I don’t take any treatment for Gout?

In the absence of appropriate treatment and care, over months to years uric acid crystals get deposited in joints and can damage them forever. They can also get deposited below skin leading to multiple swellings in the body, medically termed as Tophaceous Gout.

References for further reading

• Richette P et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016;0:1–14.
• Neogi T. In the Clinics-Gout. Ann Intern Med. 2016;165(1):ITC1-ITC16.
• Jordan MK et al. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout. Rheumatology (2007) 46 (8): 1372-1374.
• Khanna D et al. 2012 American College of Rheumatology Guidelines for Management of Gout Part I: Systematic Non-pharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care Res (Hoboken). 2012 Oct; 64(10): 1431–1446.
• Khanna D et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. 2012 Oct; 64(10): 1447–1461.