High Uric Acid: Do You Need Treatment?

Gout is a disease caused by disturbance in uric acid metabolism which gives rise to high uric acid level in the blood (hyperuricemia).

Gout can affect mainly two body parts:

• joints (gouty arthritis)
• kidneys (urate nephropathy) -which can cause kidney stones and kidney failure

Normal uric acid level in the blood varies between male and female:

• male < 420 mmol/L (7 mg/dl)
• female < 360 mmol/L (6 mg/dl)

If your uric acid level is high, then you have a higher chance of getting gout. The higher the level, the higher the risk, generally.

What if your uric acid level is slightly higher than normal limit? Do you need to get treatment to lower your uric acid level to prevent gout? 

      uric acid needle-like crystals

The most popular medicine to lower uric acid is allopurinol. This medicine can have serious side effects (hypersensitivity, though rare) and may react with other medicines you take concurrently. If you start the allopurinol treatment, you need to continue for your whole life to prevent gouty arthritis and renal impairment.

There are other treatment option like probenecid and an emerging new drug called feboxostat which has shown promising effect. However, the most cost-effective choice is still allopurinol at the moment.

The simple guide to determine whether you need drug treatment to lower your uric acid are:

• Persistent sky high uric acid level > 770mmol/l (13mg/dl) for male and >600mmol/L (10mg/dl) for female
• Three or more episodes of acute gouty arthritis in a year
• Presence of urate nephropathy (urate kidney stones / kidney damage)
• Presence of tophi (chronic tophaceous gout)
• Presence of erosive gouty arthritis (from clinical or X-ray)

      Acute gouty arthritis: red, swollen & extremely painful

      Most common site: first metatarsal phalangeal joint (podagra)

If you have one of these conditions, then you will probably benefit from treatment to lower your uric acid level. If not treated, you stand a higher risk of irreversible joint damage and kidney failure. 

Please take note that not any joint pain is related to gout. The commonest joints involved in gout is:  base of big toe → forefoot → ankle → knee → wrist → elbow → fingers

      Tophus on toe

      Multiple tophi on hands

      Tophi on pinna of the ear

You need to see a doctor to commence allopurinol, as it may precipitate gout attack.

Apart from taking medication, lifestyle changes should not be overlooked:

• Restrict high purine diet: meat, seafood, animal organs
• Restrict high fructose junk food: soft drinks etc
• Weight reduction
• Plenty of fluids intake: 2-3L/day
• Alcohol restriction
• Control co-morbidity (gout-related illness): hypertension, high lipids, high blood sugar