From the Guidelines
Elevated uric acid levels are primarily caused by a combination of dietary factors, certain medications, medical conditions, and genetic factors, which can lead to overproduction or decreased excretion of uric acid in the body. The causes of elevated uric acid levels can be broken down into several key categories:
- Dietary factors: excessive consumption of purine-rich foods like red meat, organ meats, seafood, and alcoholic beverages, particularly beer, as well as non-diet sodas and certain types of food 1
- Medications: diuretics (especially thiazides), low-dose aspirin, niacin, and some immunosuppressants like cyclosporine and tacrolimus, which can raise uric acid levels 1
- Medical conditions: obesity, metabolic syndrome, diabetes, kidney disease (including chronic kidney disease), hypothyroidism, psoriasis, and certain blood disorders like leukemia or lymphoma, which can contribute to hyperuricemia 1
- Genetic factors: inheritance of enzymes that either overproduce uric acid or reduce its elimination, which can play a significant role in hyperuricemia 1
- Other factors: rapid weight loss, dehydration, and starvation, which can temporarily increase uric acid levels due to metabolic changes 1
It is essential to identify and address person-specific risk factors for hyperuricemia, as some of these are modifiable, and managing uric acid levels can help prevent complications like gout and kidney stones 1. A comprehensive approach to managing uric acid levels typically involves dietary modifications, maintaining a healthy weight, adequate hydration, limiting alcohol intake, and in some cases, medications like allopurinol or febuxostat to reduce uric acid production or probenecid to increase its excretion.
From the FDA Drug Label
Hyperuricemia may be primary, as in gout, or secondary to diseases such as acute and chronic leukemia, polycythemia vera, multiple myeloma, and psoriasis It may occur with the use of diuretic agents, during renal dialysis, in the presence of renal damage, during starvation or reducing diets, and in the treatment of neoplastic disease where rapid resolution of tissue masses may occur. The causes of elevated uric acid include:
- Primary hyperuricemia, as in gout
- Secondary hyperuricemia due to diseases such as:
- Acute and chronic leukemia
- Polycythemia vera
- Multiple myeloma
- Psoriasis
- Use of diuretic agents
- Renal dialysis
- Renal damage
- Starvation or reducing diets
- Treatment of neoplastic disease with rapid resolution of tissue masses 2
From the Research
Causes of Elevated Uric Acid
- Elevated uric acid levels can lead to the deposition of urate crystals, causing gout, a common inflammatory arthritis 3, 4
- Hyperuricemia, or high uric acid levels, has been linked to various pathological conditions, including gout, and is often associated with comorbidities such as hypertension, hyperlipidemia, and diabetes mellitus 5, 4
- The physiological level of uric acid is crucial for maintaining health, and abnormal elevation or reduction of uric acid levels can have negative consequences 4
- Uric acid levels can be influenced by various factors, including renal function, diet, and genetic predisposition 3, 6
Factors Contributing to Elevated Uric Acid
- Renal reabsorption and the loss of uricase activity can contribute to elevated uric acid levels 4
- Certain medications, such as diuretics, can increase uric acid levels 6
- Diet and lifestyle factors, such as a high-purine diet or obesity, can also contribute to elevated uric acid levels 6, 7
- Comorbidities, such as chronic kidney disease, can affect uric acid levels and treatment outcomes 5, 7
Treatment and Management of Elevated Uric Acid
- Urate-lowering therapy (ULT) is a common treatment approach for managing elevated uric acid levels and preventing gout flares 3, 6, 7
- Medications such as allopurinol, febuxostat, and probenecid can help reduce uric acid levels 3, 6, 7
- Treatment guidelines emphasize the importance of a therapeutic serum urate target for effective gout management 6, 7