Signs of Elevated Uric Acid: What Symptoms Occur

Excess uric acid goes unnoticed for a long time: in some people it remains for years as nothing more than a line on a lab report. When urate crystals enter a joint, pain, swelling, and redness appear that are easily confused with other joint diseases. Below: which signs occur, why they are nonspecific, and what confirms an elevated level.

What elevated uric acid is

Uric acid is a breakdown product of purines, substances found in body tissues and in many foods. Most of the acid formed dissolves in the blood; the kidneys filter it and excrete it in urine. If the body produces too much of it or excretes too little, the blood level rises — this condition is called hyperuricemia.

According to EULAR recommendations, hyperuricemia is defined as a serum level of 360 µmol/L or higher. The upper limit of normal was determined from population measurements: 360 µmol/L for women and 420 µmol/L for men. Hyperuricemia accompanies various diseases — gout, lymphoma, leukemia, anemia; in China it is the second most common metabolic disease after diabetes mellitus.

Can hyperuricemia occur without symptoms

It can, and often does. An elevated level does not cause health problems in everyone; in some people uric acid forms needle-shaped crystals that may deposit in joints. Between attacks there are usually no symptoms.

Signs of elevated uric acid in the joints

This refers to gout — an inflammatory arthritis that develops when urate crystals deposit in a joint. An attack often begins suddenly, frequently at night, and the pain can be so severe that it wakes the person. Usually one joint is affected: the big toe, other toes, the foot, the ankle, the knee, the hand, the wrist, the elbow.

• intense pain that can wake you in the middle of the night;
• swelling and a feeling of heat in the joint area;
• redness of the skin over the joint — harder to notice on dark skin;
• an untreated attack lasts one to two weeks; recurrent attacks last longer;
• tophi: firm deposits under the skin on the ears, fingers, elbows — painless at first, later painful and deforming the joint.

Other symptoms: kidneys, skin, and general condition

Crystals form not only in joints but also in the kidneys — then kidney stones appear. Over time tophi damage bones and soft tissues and change the shape of joints. With long-standing untreated gout, chronic arthritis develops, although this is a rare outcome.

Triggers of an attack: an illness with high fever, a lot of alcohol or a very heavy meal, dehydration, joint injury, taking certain medications. These are not signs of hyperuricemia in themselves, but they explain why the attack happened right now.

Why the signs are nonspecific and how they are confirmed by testing

A similar picture occurs in pseudogout — calcium pyrophosphate arthritis: the same pain, swelling, and redness, but the cause is calcium deposition rather than urates. The two cannot be distinguished by the appearance of the joint, so the diagnosis is based on examination.

According to recommendations, during an appointment the doctor asks about symptoms, examines the affected joint, and asks about diet and alcohol. A blood test for uric acid is ordered, and if needed a urine test, microscopic examination of joint fluid (looking for urate crystals), ultrasound, or a special computed tomography scan. If the picture remains unclear, the patient is referred to a rheumatologist.

Risks and when to see a doctor

You should see a doctor at the first attack of gout, and also when the usual treatment stops helping. Risk is higher in men, especially with age, in overweight people, after menopause, with high cholesterol, high blood pressure, kidney disease, osteoarthritis, diabetes, after surgery or injury, and with diuretics and certain other medications. Hyperuricemia is associated with coronary risk factors, although it is not an independent factor.

Elevated uric acid by itself is not a reason to call an ambulance; 103/112 — if sudden pain and swelling in a joint are accompanied by worsening pain, very high fever, a feeling of heat, cold, or chills, nausea, or inability to eat: such signs may indicate an infection inside the joint.

It makes sense to bring your lab report to the appointment and ask what your uric acid level is relative to normal, whether additional tests are needed — a urine test, joint fluid examination, ultrasound — whether any of the medications you take could raise this level, how to distinguish gout from other arthritides, and whether a rheumatologist is needed. This material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer