It comes from substances called purines. These are found in large amounts in certain foods and drinks, like red meat, seafood, and beer. Purines are also part of the DNA in cells. When cells die and break down, they release that substance, which forms uric acid. This is dissolved in your blood and moved to your kidneys, where it’s usually eliminated through urine.
Causing hyperuricemia
Sometimes your body will have more uric acid than your kidneys can eliminate. This condition is called hyperuricemia, which means that you have higher-than-normal levels in your blood.
When levels are too high, it can form crystals in your joints and tissues, causing pain and inflammation. Everyone with hyperuricemia won’t develop gout, but it significantly raises your
risk.
Confirming your levels
If you have a painful, irritated joint, your doctor will need to perform one or more tests to confirm a diagnosis of gout. These tests will help distinguish it from other forms of arthritis, which can have similar symptoms.
Your doctor can test your blood to help confirm the diagnosis. Normal uric acid levels range from 4.0-8.5 mg/dL (milligrams per deciliter) for men and 2.5-7.5 mg/dL for women.1 If you have already been diagnosed with gout, the American College of Rheumatology guidelines recommend a uric acid level of 6.0 mg/dL or less.2 Levels above that could suggest that you have hyperuricemia. If you can get your levels to below 6 mg/dL, crystals tend to dissolve and are less likely to reform.
Your doctor may also use a needle to extract fluid from a joint that is inflamed and painful. If you have this disease, crystals will be visible when the fluid is viewed under a microscope.
After your diagnosis
Once you’re diagnosed with gout, you will probably have your acid levels checked every six months. Your doctor may also prescribe medication(s) to deal with the pain and inflammation of that comes with this diagnosis in the short term and to lower your uric acid levels in the long term.
You’ll probably start at a particular dosage, and your doctor will test your uric acid levels to see if the medicine is having the desired effect. Your medication levels may need to be slowly raised, or you may be asked to try a different medication. Once you’re on a medication that’s effective, you’ll probably be taking it long-term, in addition to any dietary and lifestyle modifications your physician may suggest.
Dietary changes
You may also be asked to make some dietary changes that can decrease your levels. The following foods and drinks should be limited, since they’re high in purines:
- Seafood, red meats, and organ meats like liver
- Drinks that are high in fructose (a type of sugar), such as non-diet sodas
- Alcohol, particularly beer and liquor
Medications that can raise uric acid levels
Certain medications can also raise the levels in your blood, so it’s important to let your doctor know about any medicine you take. If you have gout and take one of the following medicines, ask your doctor about the possibility of switching to another drug:
- Warfarin
- Diuretics – “water pills”
- Cyclosporine
- Tacrolimus
- Levodopa (often combined with carbidopa)
Controlling your uric acid levels is the key to avoiding gout flare ups.
Work with your doctor through a combination of medication and dietary changes to help lower your levels, and make sure to have your blood tested every six months.
2 “2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia.” Available at http://www.rheumatology.org/Portals/0/Files/ACR%20Guidelines%20for%20Management%20of%20Gout_Part%201.pdf. Accessed May 9, 2016.
