From the Guidelines
Elevated uric acid levels can be caused by a combination of factors, including dietary habits, medical conditions, medications, and genetic predispositions, and the most recent evidence suggests that identifying and addressing person-specific risk factors for hyperuricaemia is crucial. According to the 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout 1, risk factors for chronic hyperuricaemia should be searched for in every person with gout, specifically including chronic kidney disease (CKD), overweight, medications (such as diuretics, low-dose aspirin, cyclosporine, and tacrolimus), and consumption of excess alcohol (particularly beer and spirits), non-diet sodas, meat, and shellfish.
Some of the key factors that can contribute to elevated uric acid levels include:
- Dietary factors, such as consuming foods high in purines (red meat, organ meats, seafood, beer, and fructose-sweetened beverages)
- Certain medical conditions, like gout, kidney disease, metabolic syndrome, diabetes, and obesity
- Medications, particularly diuretics (especially thiazides), low-dose aspirin, niacin, and some immunosuppressants
- Genetic factors, with some people having inherited enzyme defects that increase uric acid production
- Rapid cell turnover conditions, such as cancer treatments, psoriasis, and hemolytic anemia, which release purines that convert to uric acid
- Fasting or severe dieting, which can temporarily elevate levels as the body breaks down tissues
- Alcohol consumption, which impairs uric acid excretion, particularly beer which also contains purines
The 2012 American College of Rheumatology guidelines for management of gout also emphasize the importance of identifying and addressing underlying causes of hyperuricemia, and recommend a thorough clinical evaluation of disease activity and burden, as well as attention to possible etiologies of hyperuricemia in each patient 1. Treatment depends on the underlying cause, but may include dietary modifications, increased hydration, weight management, and medications like allopurinol or febuxostat to reduce uric acid production or probenecid to enhance excretion.
From the Research
Causes of Elevated Uric Acid
Elevated uric acid levels can be caused by various factors, including:
- Dietary patterns: A diet high in animal-based foods and low in plant-based foods can increase uric acid levels 2
- Kidney disease: Patients with chronic kidney disease (CKD) are more likely to develop hyperuricemia and gout 3
- Gout: A condition characterized by elevated uric acid levels, which can cause joint pain and inflammation 4, 5, 6
- Medication: Certain medications, such as diuretics, can increase uric acid levels
- Genetics: Family history can play a role in the development of hyperuricemia and gout
Factors Affecting Uric Acid Levels
Several factors can affect uric acid levels, including:
- Urate-lowering therapies: Medications such as allopurinol and febuxostat can lower uric acid levels 4, 5, 3, 6
- Renal function: Impaired renal function can lead to elevated uric acid levels 3
- Dietary intake: A plant-based dietary pattern has been shown to be associated with decreased uric acid levels 2
- Age and sex: Uric acid levels can vary with age and sex, with men generally having higher levels than women 2
Management of Elevated Uric Acid
Management of elevated uric acid levels typically involves:
- Urate-lowering therapies: Medications such as allopurinol and febuxostat can be used to lower uric acid levels 4, 5, 3, 6
- Dietary changes: Adopting a plant-based dietary pattern can help reduce uric acid levels 2
- Lifestyle modifications: Maintaining a healthy weight, staying hydrated, and avoiding excessive alcohol consumption can also help manage uric acid levels