Uric Acid Info section (Understand Gout). This section explains what uric acid is, and how it causes gout. By giving you the information you need to understand uric acid, you are best placed to manage it effectively.
For more information, see my uric acid guidelines.
This article is taken from a press release titled Pathogenesis of Gout. The text is very scientific, and even an included glossary does not prevent some difficult to understand passages. The study has a very wide scope, and I will rewrite various parts of it in future articles to clarify some of the key points.
Posted on: Saturday, 8 October 2005, 03:01 CDT via science news release.
By Choi, Hyon K; Mount, David B; Reginato, Anthony M
I list a range of risky uric acid levels in my Uric Acid Levels Chart. When uric acid levels are over 6mg/dL, you remain at risk of a gout attack. You might be OK, but you might suffer the dangers of uncontrolled gout. Before I explain the risks, let’s look at the numbers.
Risky Uric Acid Levels Measurement Scale
Uric acid numbers always come with a measurement scale. The most predominant scale is mg/dL, but other scales are used, and mixing them up makes the numbers meaningless.
In construction, you might confuse centimeters and inches. In gout, you might confuse mg/dL with mmol/L or with μmol/L.
It should be obvious as mg/dL is usually in single figures or tens; mmol/L is usually in decimal fractions; and μmol/L is usually in hundreds. Unfortunately, people remember the numbers, and forget the scale. I’ve heard from many gout sufferers who think risks are low because they remember their uric acid number as “under 7,” If they actually mean 0.70 mmol/L, they are in dangerous territory.
Always be sure of your uric acid number, and always quote the measurement scale.
Risky Uric Acid Levels
I define the risky uric acid levels range as: 6.1 to 7.2mg/dl or 0.36 to 0.43mmol/L or 363 to 428μmol/L
In my opinion, this risky range is the worst there is for uric acid levels. It is not the worst range for gout, but it is the worst range in practical terms for getting proper treatment. Above this range, most doctors will help you get gout under control. In this risky uric acid levels range, you might find adequate gout treatment hard to get.
As I have explained in safe uric acid levels, 5mg/dL is recognized by most professional rheumatologists. Unfortunately, most frontline doctors are not familiar with these recommendations. Regular reader will be aware of my distress and contempt for “normal” uric acid levels. The confusion between a statistical average (around 7mg/dL), and an acceptable medical maximum (5mg/dL) means that gout patients suffer more than they need to in two important areas:
When gout symptoms are examined as gout is first suspected, reliance is often placed on uric acid blood test results. The common misdiagnosis is “It can’t be gout because uric acid is in the normal range.”
If gout symptoms are diagnosed correctly, uric acid lowering treatment should be started to make uric acid levels safe. Unfortunately many doctors do not prescribe a high enough dose, settling for results that fall in the risky, or dangerous “normal” range.
If your uric acid levels are in the risky range, you have a chance of getting gout attacks. The further you move up the scale, the greater the risks become. If you are in the 6 to 7 range, you need to stop and think about how you will proceed. Either take steps to get uric acid lower, or risk more gout attacks. As you will see in my explanation of dangerous uric acid levels, the higher up the scale you choose to go, the more you risk serious, even life-threatening, consequences.
Gouty tophi are usually noticed under the skin, and are not usually painful until they burst through the skin, or become infected.
We tend to ignore them in the early stages, and concentrate more on relieving the pain from acute gout flares.
But is this wise?
Now that technology allows us to see tophi growing into cartilage, tendons and bones, we can see it is not wise. I’ve added some more important 2014 information to this 2010 article about early detection of joint damage from new gout scanning technology. First let us see how this technology shows early tophi leading to bone erosion and severe, painful, joint damage.
But how can a weak compound like uric acid cause so much pain and misery?
When you understand the answer to that question, you will be in a much better position to understand and manage your uric acid.
I know many people want simple answers and clear instructions to manage their gout. I provide help pages on all aspects of uric acid. So that you can find practical answers fast. However, I believe that you will get better treatment if you understand gout better.
To understand gout, you need to understand its root cause – uric acid.
I have also created a separate list of urate reports. These are my summaries of uric acid studies and investigations that help you understand the nature of uric acid and how it affects your gout. Please note that I am currently reviewing all pages in this section. Because I am changing them to step-by-step formats. So, if you want an email notice when I republish pages, please subscribe to my free update service.
What Is Gout?
My simple definition is:
An immune system reaction to uric acid crystals.
I explain that in more detail below, but answering “What is gout?” is clearer if I explain what it is not. There are many misunderstandings about all aspects of gout and uric acid. Because reckless publishers on the Internet are propagating these myths. My purpose is to expose these myths and establish facts. Learning why these myths are false is also a great way to test your health advisers. Do they really know gout, or are they just spouting outdated trash? Find out in my What Is Gout guidelines.
Uric acid levels can be confusing, with different scales. Use this chart to see what your test results really mean.
Understanding uric acid levels is the most important thing you need to learn to control your gout. You cannot rely on doctors, as many simply do not understand what the levels mean. Check your levels today then see my advice if they are:
These articles explain how crystals form deposits in different parts of the body, how those urate deposits cause immune system response, and how the deposits can also cause permanent physical damage to joints (bones, cartilage, ligaments, and tendons) and organs. When organ damage occurs, it usually involves skin, kidneys and heart, but all organs are at risk, as I explain in my tophi guidelines.
Uric Acid Blood & Immune Response
These articles explain how acute gout pain arises from the immune system response to invading uric acid crystals. This response is the R in UDRP – a reaction that produces joint inflammation which leads to the pain of an acute gout flare.
Uric Acid Gout Pain
These articles discuss different manifestations of gout pain, and how permanent solutions to pain require uric acid control before irreversible physical damage leads to surgery.
Though the main symptom is pain, overloading the immune system causes many more symptoms including fever, chills, loss of appetite, and a general feeling of being ill that might cause anxiety.
My detailed explanations of symptoms are coming soon.
Other Uric Acid Pain Pathway Issues
Please see my original explanation of the UDRP Uric Acid Pain Pathway:-
If you have gout, a sauna might seem the ideal way to relax.
Yes, it keeps your gouty joints nice and warm, but what about side effects?
You need to take care in the sauna, as excess sweating can soon cause high uric acid levels.
Generally speaking, warmth is good for gout sufferers. But what happens when you get too hot and start to sweat?
There are some gout research studies in this area that have helped me get a better understanding of gout and sweating.
Uric Aid & Sweat
In, Excretion of nitrogen compounds in sweat during a sauna, D Czarnowski and J Górski determined that:
” No uric acid was detected in sweat. “
However, this was contradicted by a later study from C T Huang et al in Uric acid and urea in human sweat. They did measure small amounts of uric acid, equivalent to 6.3% of that found in the blood, though they note:
” The results indicate that sweat uric acid concentration is quite minimal, and the estimated total uric acid excretion per day in normal physiological range is insignificant. “
More importantly, they make the point that heavy sweating reduces urinary excretion of uric acid. These results are from experiments in which sweating was induced by vigorous exercise. Strenuous exercise raises uric acid levels, so I conclude that the extra uric acid from this exercise is the likeliest reason why uric acid in sweat was measurable in this study.
In 2004, T Yamamoto et al reported on Effect of sauna bathing and beer ingestion on plasma concentrations of purine bases. This study did not measure uric acid in sweat, but they do confirm that
” sauna bathing […] decreased the urinary excretion of uric acid. “
So does this get us any nearer understanding if sweating causes gout?
It seems clear to me that what causes gout here is dehydration rather than any direct effect of heat. If you want to avoid gout attacks when using the sauna, make sure you drink plenty of water.
Gout and Heat
This is a personal account of a gout sufferer who was struggling to lower uric acid despite allopurinol, as he was an under-excreter. Your circumstances may be different, but his story confirms the value of drinking plenty of water when using heat for gout.
Mick was suffering from what he describes as chronic inflammation rather than an acute gout flare. He ranks the inflammation level as 30%. He came up with the idea of turning the heating up in his home, and drinking 5 liters of water per day. After one and a half days, his inflammation was virtually gone, being 5%.
Gout Sauna: Next Steps
You have learned that sauna bathing, due to sweating can cause high uric acid. If you take part in any activity that leads to sweating, take care to replace lost fluids as soon as possible.
If you have further questions, or want to share your experiences of gout and sauna, please use the Gout Forum.
This is my original explanation of how uric acid causes gout pain, from some time before 2008. It exposes the commonly believed myth that gout pain comes from sharp uric acid crystals embedded in our joints. In truth, gout pain comes from our inflammatory reaction to these crystals, which are too small to cause physical pain. This simple misunderstanding causes all kinds of problems during diagnosis and treatment.
GoutPal.com has grown considerably since I first published this explanation on the causes of gout pain, yet this simple process continues to support everything that I do here. The U-D-R-P process has now spawned an entire section (Understanding Uric Acid) to explain how uric acid and gout interact with our immune system to produce gout.
My Symptoms, Treatment, Diet Sections offer practical help and advice for coping with gout, but understanding uric acid gives you a much better chance of managing gout completely. If you do not have time to read all the Understanding Uric Acid Section, at least take time to read and understand the principles upon which it is based…