EXPLORING THE LINK BETWEEN URIC ACID AND JOINT PAIN

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A thirty two year old overweight lady with joint pains and raised uric acid levels was advised medications to lower her uric acid by her physician. She had mild aches and pains, but no obvious joint swelling or stiffness. This is a common scenario, where patients who have joint pains are advised to check their blood for uric acid levels and are then often started on uric acid lowering medications. As a result their underlying rheumatic condition gets missed or is diagnosed late and they end up taking medications that they don't need. 

She consulted a rheumatologist who then went through her medical history and after a clinical examination reassured her that she didn’t have Gout, which is a condition associated with high blood uric acid levels and joint disease. She was advised to lose weight and maintain a healthy diet and lifestyle.

What is Uric acid?

Uric acid is an end product produced as a result of the body’s efforts in breaking down purines. Purines are present in many foods we eat such as shellfish, some seafood, red meat, and alcoholic beverages, amongst many others. Although the production of uric acid  is a very important process required for the body’s functioning, excess uric acid can cause problems. This waste product is washed out by our kidneys and excreted via urine. Uric acid can build up either due to oversupply or problems with its excretion. Oversupply is due to an excess intake of purine containing food and problems with excretion may be due to the kidney being unable to wash out the uric acid or deficiency in the enzymes that help to excrete it. The excess uric acid then gets converted into crystals and gets deposited in our joints or in the kidneys. Many health conditions such as obesity, endocrinological problems (diabetes, thyroid etc), heart, and  kidney diseases may also lead to raised blood uric acid levels. 

What is Gout?

When uric acid is deposited in the joints it can lead to inflammation, causing pain, swelling and stiffness of that particular joint. This is extremely painful and the patient may be bedridden or find it very difficult to go about their day to day life. This condition is called “Gout” and is a condition that is known since ancient times. Infamously known as “The Disease of the Kings” because King Henry the 8th suffered from gout due to his lavish lifestyle and excess alcohol consumption. Hippocrates is known to have described this condition in detail. Gout is common among middle aged men. Women suffering from chronic conditions such as heart and kidney ailments may  suffer from Gout, although this is extremely rare. 

It commonly affects the big toe, although knees, elbows or any other joint can  be affected. The affected joint is extremely swollen and inflamed and during this period there may be excruciating pain. Treatment with anti-inflammatories may be prescribed. The long term goal of treatment is to lower the uric acid levels with diet and medications, so as to avoid such flares.   

What should I do if I  have joint pains and my uric acid is high?

It is extremely important to have a physical consultation to ascertain the cause of your joint pains. The doctor will listen to your complete history, examine your joints and may prescribe additional tests as needed. It is important to rule out inflammatory conditions such as Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis before attributing your joint pain to raised uric acid levels. 

Does a high blood uric acid mean I should start medicines to lower uric acid levels?

Unless you have  the typical symptoms of Gout, starting uric acid lowering medications is not advisable. High uric levels, without any symptoms, should be initially treated with dietary and lifestyle changes. This includes a healthy balanced diet and moderate exercise as per your individual capacity and needs. If you are  obese, weight loss helps to lower the uric acid levels.  Restricting all protein containing foods is not warranted. Instead, a balanced diet containing fresh fruits and vegetables, and low in saturated fats is recommended. However if there are other coexisting conditions such as chronic kidney disease,  heart ailments or diabetes a different approach may be required and this needs to be discussed in detail with your treating physician. An individualized, holistic approach is far better than a “one size fits all” policy.

Dr. Aneesa Kapadia is a Rheumatology Consultant at Jaslok, Saifee, Prince Aly Khan, St. Elizabeth and Masina Hospitals in Mumbai.
Email address: draneesakapadia@gmail.com