From the Guidelines
Elevated uric acid levels are primarily caused by a combination of dietary factors, medical conditions, and medications, including chronic kidney disease, overweight, consumption of excess alcohol, and use of diuretics, low-dose aspirin, cyclosporine, and tacrolimus, as identified in the 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout 1. The main reasons for elevated uric acid levels can be broken down into several key categories:
- Dietary factors: consumption of excess alcohol, non-diet sodas, meat, and shellfish, which are high in purines and can increase uric acid production in the body 1.
- Medical conditions: chronic kidney disease (CKD), overweight, and obesity, which can lead to decreased excretion of uric acid through the kidneys 1.
- Medications: diuretics, low-dose aspirin, cyclosporine, and tacrolimus, which can raise uric acid levels by decreasing its excretion or increasing its production 1. It is essential to identify and address these modifiable risk factors to manage elevated uric acid levels and prevent related conditions like gout, as emphasized in the 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout 1. Some of the key strategies for managing elevated uric acid levels include:
- Gradual weight loss in obese patients to lower serum uric acid (SUA) levels and reduce the likelihood of gout flare 1.
- Limiting or avoiding foods and beverages that are high in purines, such as red meat, organ meats, seafood, and alcoholic beverages, particularly beer.
- Staying hydrated to help the kidneys excrete uric acid more efficiently.
- Taking prescribed medications, such as allopurinol or febuxostat, to reduce uric acid production or increase its excretion, as recommended by a healthcare provider.
From the Research
Elevated Uric Acid Levels: Causes and Factors
Elevated uric acid levels can be caused by various factors, including:
- Diet: consumption of purine-rich foods, sugary beverages, and fructose can increase uric acid levels 2
- Lifestyle: heavy drinking, lack of exercise, and obesity can contribute to elevated uric acid levels 2
- Medical conditions: chronic kidney disease, metabolic syndrome, and certain medications can increase uric acid levels 3
- Genetics: family history can play a role in elevated uric acid levels
Treatment and Management
Treatment for elevated uric acid levels typically involves medication, such as:
- Febuxostat: a xanthine oxidase inhibitor that can lower uric acid levels more effectively than allopurinol in some patients 4, 5, 6
- Allopurinol: a standard treatment for hyperuricemia, but may have limitations in patients with renal impairment 5
- Probenecid: a uricosuric agent that can be used as a second-line treatment 4
Lifestyle Changes
Lifestyle changes can also help manage elevated uric acid levels, including: