What happens to the body when there is excess uric acid

If your joints are swollen and painful at night, your rheumatologist will suggest you check your rheumatology profile. This examination will help make an accurate diagnosis, monitor the dynamics of the disease and prescribe the correct treatment.

If rheumatic disease is suspected, the following tests are used:

• blood test for uric acid levels;
• blood test for antinuclear antibodies;
• blood test for rheumatoid factor;
• blood test for ACCP (antibodies to cyclic citrulline-containing peptide);
• blood test for C-reactive protein.

Blood test for uric acid levels

Uric acid is the final breakdown product of purines. Every day a person receives purines through food, mainly meat products. Then, with the help of certain enzymes, purines are processed to form uric acid.

In normal physiological quantities, uric acid is needed by the body; it binds free radicals and protects healthy cells from oxidation. In addition, just like caffeine, it stimulates brain cells. However, high levels of uric acid have harmful consequences, in particular, they can lead to gout and some other diseases.

Testing uric acid levels makes it possible to diagnose uric acid metabolism disorders and related diseases.

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Rheumatological examination

2 Rheumatological examination

3 Rheumatological examination

When to conduct an examination:

• with the first attack of acute arthritis in the joints of the lower extremities, which arose without obvious reasons;
• with recurrent attacks of acute arthritis in the joints of the lower extremities;
• if you have relatives in your family who suffer from gout;
• for diabetes mellitus, metabolic syndrome;
• with urolithiasis;
• after chemotherapy and/or radiation therapy for malignant tumors (and especially leukemia);
• with renal failure (the kidneys excrete uric acid);
• as part of a general rheumatological examination necessary to determine the cause of joint inflammation;
• with prolonged fasting, fasting;
• with a tendency to excessive consumption of alcoholic beverages.

Uric acid level

The level of uric acid is determined in the blood and urine.

Uric acid in the blood is called urecemia , and in urine - uricosuria . An increased level of uric acid is hyperuricemia , a decreased level of uric acid is hypouricemia . Only hyperuricemia and hyperuricosuria are of pathological significance.

The concentration of uric acid in the blood depends on the following factors:

• the amount of purines entering the body with food;
• synthesis of purines by body cells;
• the formation of purines due to the breakdown of body cells due to disease;
• the function of the kidneys, which excrete uric acid in the urine.

Under normal conditions, our body maintains normal uric acid levels. An increase in its concentration is one way or another associated with metabolic disorders.

Normal levels of uric acid in the blood

Men and women may have different concentrations of uric acid in the blood. The norm may depend not only on the gender, but also on the age of the person:

• in newborns and children under 15 years of age – 140-340 µmol/l;
• in men under 65 years old – 220-420 µmol/l;
• in women under 65 years of age – 40-340 µmol/l;
• in women over 65 years of age – up to 500 µmol/l.

If excess of the norm occurs for a long time, then crystals of uric acid salt (urate) are deposited in joints and tissues, causing various diseases.

Hyperuricemia has its own symptoms, but can also be asymptomatic.

Reasons for increased uric acid levels:

• taking certain medications, such as diuretics;
• pregnancy;
• intense loads in athletes and people engaged in heavy physical labor;
• prolonged fasting or eating foods containing large amounts of purines;
• some diseases (for example, endocrine), consequences of chemotherapy and radiation;
• impaired metabolism of uric acid in the body due to a deficiency of certain enzymes;
• insufficient excretion of uric acid by the kidneys.

How to reduce uric acid levels

Those who suffer from gout know how much trouble an increased concentration of uric acid can cause. Treatment of this disease must be comprehensive and must include taking medications that reduce the concentration of uric acid in the blood (xanthine oxidase inhibitors). It is recommended to drink more fluids and reduce the consumption of foods rich in purines.

It is also important to gradually lose excess weight, since obesity is usually associated with increased uric acid. The diet should be designed so that the amount of foods rich in purines is limited (red meat, liver, seafood, legumes). It is very important to give up alcohol. It is necessary to limit the consumption of grapes, tomatoes, turnips, radishes, eggplants, sorrel - they increase the level of uric acid in the blood. But watermelon, on the contrary, removes uric acid from the body. It is useful to consume foods that alkalize urine (lemon, alkaline mineral waters).

Positive effects of hyperuricemia

Paradoxically, a high level of purine metabolic product in the blood, according to a number of researchers, has a beneficial effect on the body and allows the correction of some pathological conditions:

• Numerous studies from the 60-70s. confirmed a higher level of intelligence and reaction speed in patients with acute hyperuricemia. The chemical structure of the acid is similar to trimethylated xanthine caffeine, and as a result, it is believed to be capable of increasing performance.
• Increased acid levels promote longevity by acting as an antioxidant that blocks peroxynitrite, superoxide, and iron-catalyzed oxidative reactions. Transfusion of uric acid enhances the antioxidant activity of blood serum and improves endothelial function.
• Uric acid is a powerful neuroprotector, inhibitor of neuroinflammation and neurodegeneration, reducing the risk of Parkinson's disease and Alzheimer's disease.

However, such a positive effect is observed with an acute increase in acid in the blood. Chronic hyperuricemia leads to endothelial dysfunction and promotes the development of the oxidative process.

Antinuclear antibodies (ANA)

Using the ANA test, you can determine the presence of antinuclear antibodies (antibodies to nuclear antigens) in the blood.

ANAs are a group of specific autoantibodies that are produced by our body's immune system in case of autoimmune disorders. Antibodies have a damaging effect on the body's cells. In this case, a person experiences various painful symptoms, such as pain in muscles and joints, general weakness, etc.

Detection of antibodies belonging to the ANA group (for example, antibodies to double-stranded DNA) in blood serum helps to identify an autoimmune disease, monitor the course of the disease and the effectiveness of its treatment.

1 Blood test for ACCP

2 Blood test for C-reactive protein

3 Blood test for ACCP

When is a blood test for antinuclear antibodies necessary?

Detection of antinuclear antibodies may be a sign of the following autoimmune diseases:

• polymyositis;
• dermatomyositis;
• systemic lupus erythematosus;
• mixed connective tissue disease;
• scleroderma;
• Sjögren's syndrome and disease;
• Raynaud's syndrome;
• autoimmune hepatitis

How is the antinuclear antibody test performed?

Blood for antinuclear antibodies is taken from a vein in the elbow, on an empty stomach. Before the study, you do not have to adhere to any diet.

In some cases, in order to differentiate various autoimmune diseases, additional clarifying tests for autoantibodies from the group of antinuclear antibodies, the so-called ANA immunoblot, may be required.

What do the test data mean?

Antinuclear antibodies (another name is antinuclear factor ) indicate the presence of some kind of autoimmune disorder, but do not precisely indicate the disease that caused it, since the ANA test is a screening test. The goal of any screening is to identify people at increased risk of a particular disease.

A healthy person with normal immunity should not have antinuclear antibodies in the blood or their level should not exceed the established reference values.

A normal ANA value implies an antibody titer not exceeding 1: 160. Below this value, the test is considered negative.

A positive test for antinuclear antibodies (1:320 or more) indicates an increase in antinuclear antibodies and the presence of a disease of an autoimmune nature in a person.

Currently, two methods are used to detect antinuclear antibodies: indirect immunofluorescence reaction using the so-called Hep2 cell line and enzyme-linked immunosorbent assay. Both tests complement each other, and therefore they are recommended to be performed simultaneously.

The following types of ANA antinuclear bodies can be distinguished in the indirect immunofluorescence reaction:

• homogeneous coloring - can be with any autoimmune disease;
• spotty or speckled coloration may occur with systemic lupus erythematosus, scleroderma, Sjögren's syndrome, rheumatoid arthritis, polymyositis and mixed connective tissue disease;
• peripheral coloring – characteristic of systemic lupus erythematosus;

If the test for antinuclear antibodies is positive, it is necessary to perform an immunoblot of antinuclear antibodies to clarify the type of autoimmune disease and make a diagnosis.

Nutrition rules to reduce it

In addition to excluding “harmful” products and including “healthy” ones, the patient should adhere to additional recommendations, namely:

• eat in small portions;

The more meals the better, but portions should be small. Also, to speed up your metabolism, you can grind food in a blender - this will speed up the removal of purines from the blood.

• lead to normal weight;

Excess body weight negatively affects the rate of elimination of waste products. Therefore, you should normalize your weight to speed up the process.

• include diuretics;

We are not talking about medications. This includes products that stimulate the kidneys, and, accordingly, remove harmful components from the body, preventing the occurrence of stones. Such products include watermelon with chamomile tea.

Rheumatoid factor

A blood test for rheumatoid factor is aimed at identifying specific IgM class antibodies to IgG class antibodies.

A laboratory test for rheumatoid factor is a screening test aimed at identifying autoimmune disorders. The main objective of the study for rheumatoid factor is to identify rheumatoid arthritis, Sjogren's disease and syndrome and a number of other autoimmune diseases.

A rheumatoid factor test may be needed for the following symptoms:

• pain and swelling in the joints;
• limited mobility in joints;
• feeling of dryness in the eyes and mouth;
• skin rashes like hemorrhages;
• weakness, loss of strength.

1 Rheumatoid arthritis

2 Rheumatological examination

3 Rheumatological examination

Norms of rheumatoid factor in the blood

Theoretically, rheumatoid factor should not exist in a healthy body. But still, in the blood of some, even healthy people, this factor is present in a small titer. Depending on the laboratory, the upper limit of normal for rheumatoid factor varies from 10 to 25 international units (IU) per milliliter of blood.

Rheumatoid factor is the same in women and men. In older people, the rheumatoid factor level will be slightly higher.

The normal rheumatoid factor in a child should be 12.5 IU per milliliter.

Rheumatoid factor testing is used to diagnose the following diseases:

• rheumatoid arthritis;
• systemic autoimmune diseases;
• Rioglobulinemia.

Other causes of elevated rheumatoid factor

Additional reasons for increased rheumatoid factor may be the following:

• syphilis;
• rubella;
• Infectious mononucleosis;
• malaria;
• tuberculosis;
• flu;
• hepatitis;
• leukemia;
• cirrhosis of the liver;
• sepsis

If the cause of increased rheumatoid factor is an infectious disease, for example, infectious mononucleosis, then the titer of rheumatoid factor is usually less than with rheumatoid arthritis.

However, rheumatoid factor testing primarily helps to recognize rheumatoid arthritis. However, it should be emphasized that it is impossible to make a diagnosis on its basis alone. Since rheumatoid factor can be elevated in many other pathological conditions of an autoimmune and non-autoimmune nature. In addition, in approximately 30% of patients with rheumatoid arthritis, a blood test for rheumatoid factor may be negative (seronegative rheumatoid arthritis).

A blood test for rheumatoid factor is carried out in the morning on an empty stomach (8 to 12 hours should pass since the last meal).

Localizations

With gout, gouty arthritis of the joints of the lower extremities most often develops. There may be other localizations, including damage to the joints of the upper extremities. Gout is also characterized by asymmetrical joint lesions.

Gouty arthritis of the lower extremities

During a primary gouty attack, the pathological process in half of the cases involves the 1st metatarsophalangeal joint of the foot. And even if this joint is not the first to be affected, gouty arthritis will still develop in it later. The periarticular tissues swell, the skin turns red. Subsequently, small and large tophi appear on the dorsum of the foot.

Gouty arthritis of the ankle is less common and most cases occur with repeated attacks. The ankle becomes inflamed, swollen and red, and the inflammation spreads to the heel. There is severe pain and the inability to step on the foot.

The knee is often affected, the lesions are asymmetrical, often combined with lesions of the 1st metatarsophalangeal and elbow joints. Severe pain, swelling and redness are initially combined with impaired limb function due to pain, but with prolonged gout, joint deformation and ankylosis (immobility) occur.

Hip gouty arthritis is rare and the redness and swelling are not so noticeable under the thick layer of muscles and ligaments. But the pain can be severe.

Chondroprotectors: what are they, how to choose, how effective are they?

Joint pain at rest

Gouty arthritis of the upper extremities

The small joints of the hand and fingers often become inflamed, and the fingers become like sausages. The pain, inflammation and swelling are very severe. Large tofuses appear on the back of the hand.

The elbow is no less often affected. The lesions are asymmetrical and are often combined with the involvement of small joints of the hand and foot. Small and large tophi appear on the extensor surface of the shoulder and forearm.

Brachial gouty arthritis develops much less frequently, but is painful. Swelling and redness are not expressed, tophi appear on the flexor surface of the shoulder.

Lesions in gouty arthritis of the upper extremities are usually asymmetrical

Tofus lesion of the spine

In the mid-50s of the last century, spinal damage due to gout was first identified. In this case, tophi grow in the soft tissues and joints of the spine with the destruction of their structures.

The lumbar region is most often affected, followed by the cervical region. Pain appears in the back, which is often mistaken for symptoms of osteochondrosis. When the vertebrae are destroyed and the spinal nerves and spinal cord are compressed, neurological symptoms appear. When the cervical spine is affected, this results in paresis and paralysis of the upper limbs, and radicular pain.

When the lumbosacral region is affected, it can be complicated by compression of the final part of the spinal cord - the cauda equina. In this case, the function of the pelvic organs is disrupted - involuntary urination, defecation, and potency disorders occur.

ACDC

A blood test for ACCP consists of determining the titer of antibodies to cyclic citrullinated peptide and is one of the accurate methods for confirming the diagnosis of rheumatoid arthritis. With its help, the disease can be detected several years before symptoms appear.

What does the ACDC analysis show?

Citrulline is an amino acid that is a product of the biochemical transformation of another amino acid - arginine. In a healthy person, citrulline does not take part in protein synthesis and is completely eliminated from the body.

But with rheumatoid arthritis, citrulline begins to integrate into the amino acid peptide chain of proteins in the synovial membrane and cartilage tissue of the joints. The “new” modified protein, which contains citrulline, is perceived by the immune system as “foreign” and the body begins to produce antibodies to citrulline-containing peptide (ACCP).

ACCP is a specific marker of rheumatoid arthritis, a kind of harbinger of the disease at an early stage, with high specificity. Antibodies to cyclic citrullinated peptide are detected long before the first clinical signs of rheumatoid arthritis and remain throughout the disease.

Methodology of analysis and its significance

To detect ACCP, an enzyme-linked immunosorbent assay is used. A blood test for ACCP is carried out according to the “in vitro” principle (translated from Latin - in a test tube), serum from venous blood is examined. The ACCP blood test can be ready within 24 hours (depending on the type of laboratory).

Detection of ACCP in rheumatoid arthritis may indicate a more aggressive, so-called erosive form of the disease, which is associated with more rapid resolution of joints and the development of characteristic joint deformities.

If the test result for ACCP is positive, then the prognosis for rheumatoid ACCP arthritis is considered less favorable.

1 Blood test for ACCP

2 Blood test for C-reactive protein

3 Blood test for ACCP

ACDC. Reference values

The normal range for the ACCP test is approximately 0-5 U/mL. The so-called “ ACCP norm ” may vary depending on the laboratory. The “ACCP norm” values ​​for women and men are the same.

The so-called “ Increased ACCP ”, for example, ACCP 7 units/ml or more, indicates a high likelihood of rheumatoid arthritis. An analysis result assessed as “ ACCP negative ” reduces the likelihood of rheumatoid arthritis, although it does not completely exclude it. A rheumatologist with experience in diagnosing and treating rheumatoid arthritis should always evaluate the ACCP values ​​and interpret them; only a rheumatologist can take into account all the nuances.

To get tested for ACCP, you need to come for examination on an empty stomach.

Indications for the purpose of analysis:

• rheumatoid arthritis;
• early synovitis;
• osteoarthritis;
• polymyalgia rheumatica;
• psoriatic arthritis;
• Raynaud's disease;
• reactive arthritis;
• sarcoidosis;
• scleroderma;
• Sjögren's syndrome;
• SLE;
• vasculitis;
• juvenile RA.

If you want to know the cost of a blood test for ACCP, please call.

Contact center specialists will tell you the price of the ACDC and explain how to prepare for the study.

Frequently asked questions about the disease

Is it possible to get disability?

For chronic tophi gouty arthritis with impaired joint function.

Which doctor treats you?

Rheumatologist.

What prognosis do doctors usually give?

With proper systematic treatment under the supervision of a physician, the prognosis is favorable.

Gouty arthritis requires constant monitoring by a rheumatologist, urate-lowering therapy, diet and all doctor’s recommendations. If treated correctly, you can forget about gout attacks forever. Doctors at the Paramita clinic have extensive experience in treating gout. Contact us!

Literature:

1. Fedorova A. A., Barskova V. G., Yakunina I. A., Nasonova V. A. Short-term use of glucocorticoids in patients with prolonged and chronic gouty arthritis. Part III. Frequency of development of adverse reactions // Scientific and practical rheumatology. 2009; No. 2. pp. 38–42.
2. Eliseev M. S. Gout. In the book: Russian clinical guidelines. Rheumatology / Ed. E. L. Nasonova. M.: GEOTAR-Media, 2021. pp. 372–385.
3. Rainer TH, Cheng CH, Janssens HJ, Man CY, Tam LS, Choi YF Oral prednisolone in the treatment of acute gout: a pragmatic, multicenter, double-blind, randomized trial // Ann Intern Med. 2016; 164(7):464–471.
4. Reinders M., van Roon E., Jansen T., Delsing J., Griep E., Hoekstra M. et al. Efficacy and tolerability of urate-lowering drugs in gout: a randomized controlled trial of benzbromarone versus probenecid after failure of allopurinol // Ann Rheum Dis. 2009; 68:51–56.

Themes

Arthritis, Joints, Pain, Treatment without surgery Date of publication: 01/25/2021 Date of update: 02/02/2021

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C-reactive protein test

C-reactive protein ( CRP ) is a very sensitive element of a blood test that quickly responds to even the slightest damage to body tissue. The presence of C-reactive protein in the blood is a harbinger of inflammation, injury, and the penetration of bacteria, fungi, and parasites into the body.

CRP more accurately shows the inflammatory process in the body than ESR (erythrocyte sedimentation rate). At the same time, C-reactive protein quickly appears and disappears - faster than the ESR changes.

Due to the ability of C-reactive protein to appear in the blood at the very peak of the disease, it is also called “acute phase protein.”

As the disease enters the chronic phase, C-reactive protein decreases in the blood, and when the process worsens, it increases again.

C-reactive protein is normal

C-reactive protein is produced by liver cells and is found in minimal amounts in the blood serum. The content of CRP in blood serum does not depend on hormones, pregnancy, gender, or age.

The norm of C-reactive protein in adults and children is the same - less than 5 mg/l (or 0.5 mg/dl).

A blood test for C-reactive protein is taken from a vein in the morning, on an empty stomach.

1 Blood test for uric acid levels

2 blood test for antinuclear antibodies

3 Blood test for rheumatoid factor

Causes of increased C-reactive protein

C-reactive protein may be elevated in the presence of the following diseases:

• rheumatism;
• acute bacterial, fungal, parasitic and viral infections;
• gastrointestinal diseases;
• focal infections (for example, chronic tonsillitis);
• sepsis;
• burns;
• postoperative complications;
• myocardial infarction;
• bronchial asthma with inflammation of the respiratory system;
• complicated acute pancreatitis;
• meningitis;
• tuberculosis;
• tumors with metastases;
• some autoimmune diseases (rheumatoid arthritis, systemic vasculitis, etc.).

With the slightest inflammation, in the first 6-8 hours the concentration of C-reactive protein in the blood increases tenfold. There is a direct relationship between the severity of the disease and changes in CRP levels. Those. The higher the concentration of C-reactive protein, the stronger the inflammatory process develops.

Therefore, changing the concentration of C-reactive protein is used to monitor and control the effectiveness of treatment of bacterial and viral infections.

Different reasons lead to different increases in C-reactive protein levels:

• The presence of chronic bacterial infections and some systemic rheumatic diseases increases C-reactive protein to 10-30 mg/l. With a viral infection (if there is no injury), the level of CRP increases slightly. Therefore, high values ​​indicate the presence of a bacterial infection .
• If neonatal sepsis is suspected, a CRP level of 12 mg/l or more indicates the need for urgent antimicrobial therapy.
• In acute bacterial infections, exacerbation of some chronic diseases, acute myocardial infarction and after surgery, the highest level of CRP is from 40 to 100 mg/l. With proper treatment, the concentration of C-reactive protein decreases within the next few days, and if this does not happen, it is necessary to discuss other antibacterial treatment. If after 4-6 days of treatment the CRP value has not decreased, but remains the same and even increased, this indicates the occurrence of complications (pneumonia, thrombophlebitis, wound abscess, etc.). After surgery, the more severe the operation, the higher the CRP will be.
• During myocardial infarction, protein increases 18-36 hours after the onset of the disease, decreases after 18-20 days and returns to normal by 30-40 days. With angina pectoris, it remains normal.
• In a variety of tumors, elevated levels of C-reactive protein can serve as a test to assess tumor progression and disease recurrence.
• Severe general infections, burns, sepsis increase C-reactive protein to enormous values: up to 300 mg/l or more.
• With proper treatment, the level of C-reactive protein decreases already on days 6-10.

Preparation for rheumatological tests

In order for analyzes to show objective information, it is necessary to adhere to certain rules. You need to donate blood in the morning, on an empty stomach. Approximately 12 hours should pass between taking tests and eating. If you're thirsty, drink some water, but not juice, tea or coffee. It is necessary to exclude intense physical exercise and stress. You cannot smoke or drink alcohol.

The multidisciplinary clinic "MedicCity" provides diagnostics of the highest level, experienced, qualified rheumatologists and specialists in more than 30 specialties. We treat arthritis, arthrosis, vasculitis, lupus erythematosus, osteoporosis, gout, rheumatism and many other rheumatological diseases. Do not delay your visit to the doctor, contact us at the slightest symptoms. High-quality diagnosis is 90% of successful treatment!

Treatment methods for gout

Treatment for gout is aimed at:

• in case of an acute attack - to relieve it;
• in the remission stage - to normalize uric acid metabolism. Of course, one should strive to eliminate the cause of the disease. However, if the cause of gout is fermentopathy, this is impossible. In this case, treatment will be symptomatic.
• for the treatment of concomitant diseases.

A complete cure for gout is impossible. However, with medical help, it is possible to reduce the frequency of attacks and achieve a significant increase in periods of remission.

Which doctor treats gout?

For treatment of gout, you should consult a rheumatologist. The help of an orthopedic doctor may be required (for example, if surgery is necessary).

Treatment of an acute attack

First of all, the patient needs rest. The inflamed joint should be immobilized. It is recommended to apply cold. You need to drink plenty of alkaline fluids - up to 3 liters per day. It is important to follow a diet: foods high in purine bases should be excluded. Painkillers (NSAIDs) and glucocorticoids are used as prescribed by a doctor. Local treatment is carried out using ointments and gels that have anti-inflammatory and analgesic effects.

When the patient feels better, physical therapy is included in the treatment. Electrophoresis, UV irradiation, and UHF are used.

Treatment of gout in remission

Treatment in remission includes:

• lifestyle changes (primarily giving up alcohol);
• diet (exclude foods that contain a lot of purines - fish, mushrooms, legumes). The diet must be prescribed by a doctor;
• drug therapy (anti-gout drugs);
• local treatment - applications of medications, physiotherapy, massage, medicinal baths (in sanatoriums);
• surgical treatment: removal of tophi that are not amenable to conservative treatment, surgical restoration of affected joints.

Make an appointment Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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