If your uric acid level is high, take a look at this article. It contains everything you need to know!

Author: Deng Xuerong, Chief Physician, Peking University First Hospital

Reviewer: Mu Rong, Chief Physician, Peking University Third Hospital

Vice Chairman of the Young and Middle-aged Committee of the Chinese Medical Association Rheumatology Branch

The prevalence of hyperuricemia in my country has reached more than 10%, and it is increasing year by year, showing a trend of becoming younger.

When blood uric acid rises and there are certain triggers, gout attacks may occur. Generally, patients have had hyperuricemia for many years before gout attacks.

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So, how is uric acid produced? How to determine if you have high uric acid?

1. How is uric acid produced? How high is considered high?

Uric acid is a product of purine metabolism in the body. Purine can be endogenous or exogenous. Exogenous purine is mainly dietary intake, such as animal offal, broth, shellfish and seafood, which are all high-purine foods; endogenous purine is produced by normal cell metabolism.

Under normal circumstances, blood uric acid is in a dynamic equilibrium process. While uric acid is produced, part of it is excreted from the kidneys in the urine.

When the intake is too much and the excretion is too little, it will cause an increase in blood uric acid, leading to hyperuricemia.

Currently, it is believed that if the blood uric acid level is above 420μmol/L twice measured on different days, it is considered hyperuricemia. The standards are the same for men and women.

You may not feel anything at first, but when the blood uric acid rises to a certain level, or persists for a long time, under certain inducements, such as large intake of high-purine foods, or after strenuous exercise, severe redness, swelling, heat and pain in the joints may occur, which is called a gout attack.

2. Besides causing gout, what other dangers does hyperuricemia have?

In addition to being deposited in the joints and causing gout attacks, a lot of uric acid is excreted from the kidneys, so urate crystals or uric acid stones will form in the kidneys, causing chronic uric acid nephropathy.

Hyperuricemia is also a risk factor for many other metabolic diseases, such as coronary heart disease, hypertension, diabetes, hyperlipidemia, etc. They are all metabolic diseases, promoting and influencing each other. If one indicator is not well controlled, the other indicator will not be easy to control either, so these risk factors must be controlled simultaneously.

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3. Do I need to take uric acid-lowering drugs if I have high uric acid?

If there are no symptoms, the blood uric acid level is below 540μmol/L, and there are no other chronic diseases, it is not recommended to start drug treatment immediately. You can first control your diet and increase exercise, control your weight, and monitor changes in blood uric acid levels.

If the blood uric acid level does not reach 540μmol/L, but there are chronic diseases such as hypertension, diabetes, and atherosclerosis, uric acid-lowering drug treatment should be started as soon as possible.

If the blood uric acid level is above 540μmol/L and gout has occurred more than 2 times, initial drug treatment is required, combined with improvements in lifestyle.

Currently, there are two main types of uric acid-lowering drugs. One type is drugs that reduce the production of uric acid, such as allopurinol and febuxostat; the other type is drugs that promote the excretion of uric acid from the kidneys, such as benzbromarone.

By measuring the 24-hour urine uric acid excretion rate, it can be determined whether the kidneys are poorly excreted and the excretion of uric acid from the kidneys is too little. In this case, drugs that promote uric acid excretion can be used. If a lot of uric acid has been excreted from the kidneys, it is recommended to use drugs that inhibit uric acid production.

Among these uric acid-lowering drugs, one drug is usually started, starting at a small dose and lasting for a full course of treatment. In this case, if uric acid is still not effectively controlled, consider using other uric acid-lowering drugs in combination.

In most cases, patients with hyperuricemia may need to take uric acid-lowering drugs for a long time, because new uric acid is synthesized in the body every day. Stopping the drug may cause blood uric acid to rise again, requiring long-term treatment.

We hope that patients can control their diet and manage their weight and lifestyle while taking medication to minimize their dependence on uric acid-lowering drugs.

4. What is the ideal reduction in blood uric acid?

Generally speaking, we hope that uric acid will drop below 360μmol/L.

For patients with a large number of tophi and a heavy uric acid load, it is hoped that the level can be reduced to below 300μmol/L.

It should be noted that the lower the blood uric acid level, the better. Uric acid is a normal component of the body. Foreign studies have reported that if it is lowered too low, it may increase the risk of dementia, so it is not recommended to lower it as low as possible.