Uric acid is a chemical which is created when the body breaks down an organic compound called purines. Purines can be exogenous or endogenous. Endogenous means purines are produced by the body, whereas exogenous purines come from items we consume.

The body usually dissolves uric acid in the blood, which then travels to the kidneys and is excreted through our urine. When the body creates an excessive amount of uric acid (also called hyperuricaemia) or is unable to remove sufficient amounts, this leads to illness and certain health conditions.

Image reference: Țăpoi, L., Șalaru, D.L., Sascău, R., & Stătescu, C. (2021). Uric acid - an emergent risk marker for thrombosis?

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Gout is the most common inflammatory arthritis condition, which is caused by raised serum uric acid (SUA).

Symptoms These common symptoms associated with gout affect one or more joints, mostly the big toe: Pain Swelling Redness Tenderness

Risk factors

The following are factors which increase uric acid levels:

• Diet – includes liver, anchovies, mackerel, dried beans, red meat, shellfish, high sugar drinks, alcohol (mainly beer).
• Being overweight – the body creates higher amounts of uric acid, making it more difficult for the kidneys to eliminate it.
• Medical conditions – diabetes, metabolic syndrome, heart and kidney conditions.
• Medications – low-dose aspirin, high blood pressure medication.
• Family history.
• Sex – occurs more often in males, however post-menopausal women have the same risk factor levels.

A 2024 prospective cohort study (Adherence to healthy and unhealthy plant-based diets and the risk of gout) analysed data from the Health Professionals Follow-Up Study (1986-2012) and the Nurses’ Health Study (1984-2010). Participants included men and women who were without gout at baseline. The study looked at data from March 2020 to August 2023.

The findings from the research support current dietary recommendations. A diet consisting of a higher intake of healthy plant-based foods was associated with reduced gout risk, and regular consumption of less healthy plant-based foods was related to higher risk of gout, particularly in women.

Healthy plant-based foods included whole grains, fruits, vegetables, nuts, legumes, and vegetable oils. However, despite vegetable oil being classed as a healthy plant-based food, the study found it was associated with a higher risk of gout.

Less healthy plant-based foods comprised of fruit juice, sugar-sweetened beverages, refined grains, potatoes, sweets and desserts. The results also showed that regardless of the refined grains, potatoes, sweets and desserts being categorised as a less healthy food, they did not show an association with increased gout risk.

Uric acid and thrombosis

Research has found that raised uric acid levels is linked to compromised endothelial function, inflammatory response, prothrombotic state and thrombogenicity (the predisposition of a material to generate blood clotting when it comes into contact with the blood). Observational and experimental research studies have suggested that hyperuricaemia increases the risk of VTE.

The mechanisms involved with this association is thought to be the activation of the inflammation pathway which is provoked by elevated SUA. Inflammatory diseases, such as gout, are considered to increase the risk of VTE.

Information regarding normal uric acid values vary, with some suggesting a reading below 6.8 mg/dL is considered normal and above 8mg/dL is seen as very high and is indicative of hyperuricaemia. Ranges for males and females also vary.

Men – 3.4-7.0 mg/dL

Women – 2.4-6.0 mg/dL

Elevated SUA values may be associated with your risk of gout or similar related health conditions, however in respect to VTE risk, some research has provided different levels. Research from 2021 investigating the relationship between SUA and VTE found levels below 4.37 mg/dL were at a lower risk, and the groups which had values between 4.38-5.54 or ≥5.55 mg/dL had more than a 3-fold increased risk of VTE recurrence.

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References

• What Are Purines? | Arthritis-health
• Uric acid - blood : MedlinePlus Medical Encyclopedia
• High uric acid level - Mayo Clinic
• Gout - Symptoms and causes - Mayo Clinic
• Hyperuricemia - StatPearls - NCBI Bookshelf (nih.gov)
• Normal Uric Acid Levels | New Health Advisor
• Ji, L., & Shu, P. (2023). A Mendelian randomization study of serum uric acid with the risk of venous thromboembolism. Arthritis Res Ther 25, 122 (2023). https://doi.org/10.1186/s13075-023-03115-6.
• Kubota, Y., McAdams-DeMarco, M., & Folsom, A.R. (2016). Serum uric acid, gout, and venous thromboembolism: The atherosclerosis risk in communities study. Thrombosis Research, 144, 144–148. https://doi.org/10.1016/j.thromres.2016.06.020
• Țăpoi, L., Șalaru, D.L., Sascău, R., & Stătescu, C. (2021). Uric acid - an emergent risk marker for thrombosis? J Clin Med.;10(10):2062. doi: 10.3390/jcm10102062.
• Weng H. et al. (2023). Association between uric acid and risk of venous thromboembolism in East Asian populations: a cohort and Mendelian randomization study. Lancet Reg Health West Pac. 2023 Jul 26;39:100848. doi: 10.1016/j.lanwpc.2023.100848.