What is uric acid

Uric acid is produced by the breakdown of purines. Purines are nitrogen-containing compounds found in the cells of the body, including your DNA. Uric acid test measures the level of uric acid in the blood or urine. Most uric acid dissolves in blood and travels to the kidneys, where it passes out in urine. If your body produces too much uric acid or does not remove enough of it, you may get sick. A high level of uric acid in the body is called hyperuricemia and it can lead to gout or kidney damage.

As cells get old and die, they break down, releasing purines into the blood. To a lesser extent, purines may come from the digestion of certain foods, such as liver, anchovies, mackerel, dried beans and peas and certain alcoholic drinks, primarily beer. Most uric acid is removed from the body by the kidneys and is eliminated from the body in the urine, with the remainder eliminated in the stool.

If too much uric acid is produced or not enough is removed, it can accumulate in the body, causing increased levels in the blood (hyperuricemia). The presence of excess uric acid can cause gout, a condition characterized by inflammation of the joints due to the formation of uric acid crystals in the joint (synovial) fluid. Excess uric acid can also be deposited in tissues such as the kidney, leading to kidney stones or kidney failure.

The build-up of too much uric acid in the body can be due to producing too much, not eliminating enough, or a combination of both. Elevated levels of uric acid can occur when there is an increase in cell death, as seen with some cancer therapies or, rarely, as an inherited tendency to produce too much uric acid. Decreased elimination of uric acid is often a result of impaired kidney function due to kidney disease.

Figure 1. Uric acid crystals

Figure 2. Uric acid stones (kidney stones)

Uric acid test

No test preparation may be needed. However, some institutions recommend fasting for 4 or more hours. Follow any instructions provided and be sure to discuss with your healthcare practitioner any medications you take before having this test performed.

A blood sample is obtained by inserting a needle into a vein in the arm. A 24-hour urine sample may be collected for the urine uric acid test.

• The uric acid blood test is used to detect high levels of this compound in the blood in order to help diagnose gout. The test is also used to monitor uric acid levels in people undergoing chemotherapy or radiation treatment for cancer. Rapid cell turnover from such treatment can result in an increased uric acid level.
• The uric acid urine test is used to help diagnose the cause of recurrent kidney stones and to monitor people with gout for stone formation. This test may be done to help determine the cause of a high uric acid level in the blood. It may also be done to monitor people with gout, and to choose the best medicine to lower the uric acid level in the blood. This test may also be done to check whether a high uric acid level is causing kidney stones. A 24-hour urine sample is often needed. You will need to collect your urine over 24 hours. Your health care provider will tell you how to do this. Follow instructions exactly so that the results are accurate. Be aware that alcoholic drinks, vitamin C, and x-ray dye can also affect test results. Your health care provider may ask you to temporarily stop taking medicines that may affect the test results. Be sure to tell your provider about all the medicines you take. These include:
  • Aspirin or aspirin-containing medicines
  • Gout medicines
  • Nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen)
  • Water pills (diuretics)
  • DO NOT stop taking any medicine before talking to your provider.

When is uric acid test ordered?

The uric acid blood test is ordered when a healthcare practitioner suspects that someone has a high uric acid level. Some people with high levels of uric acid have a disease called gout, which is a common form of arthritis. People with gout suffer from joint pain, most often in their toes, but in other joints as well. The test is also ordered when cancer patients undergoing chemotherapy or radiation therapy to ensure that uric acid levels do not get dangerously high. Rapid weight loss, which may occur with such treatments, can increase the amount of uric acid in your blood.

The urine uric acid test may be ordered when a person suffers from recurrent kidney stones or has gout and needs to be monitored for formation of these stones.

Normal uric acid level

• Normal values range between 3.5 to 7.2 milligrams per deciliter (mg/dL).
• Normal urine uric acid levels range from 250 to 750 milligrams per 24 hours (1.48 to 4.43 millimoles per 24 hours).

Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What does the uric acid test result mean?

Blood uric acid levels

Higher than normal uric acid levels in the blood is called hyperuricemia and can be caused by producing too much uric acid in the body or the inability of the kidneys to adequately remove enough uric acid from the body. Further investigation is needed to determine the cause of the overproduction or decreased elimination of uric acid.

There are several genetic inborn errors that affect the break-down of purines. Cancer that has spread from its original location (metastatic), multiple myeloma, leukemias, and cancer chemotherapy can cause increased production of uric acid. Chronic renal disease, acidosis, toxemia of pregnancy, and alcoholism can cause decreased elimination of uric acid.

Increased concentrations of uric acid can cause crystals to form in the joints, which can lead to the joint inflammation and pain characteristic of gout. Uric acid can also form crystals or kidney stones that can damage the kidneys.

The American College of Rheumatology published guidelines on the management of gout in 2012 that recommend that target serum urate (uric acid) levels should be below 6 mg/dL for people diagnosed with the condition.

High uric acid  (hyperuricemia) causes:

• Acidosis
• Alcoholism
• Chemotherapy-related side effects
• Diabetes
• Excessive exercise
• Gout
• Hypoparathyroidism
• Lead poisoning
• Leukemia
• Medullary cystic kidney disease
• Nephrolithiasis
• Polycythemia vera
• Purine-rich diet
• Renal failure
• Toxemia of pregnancy

Lower-than-normal levels of uric acid may be due to:

• Fanconi syndrome
• Low purine diet
• Syndrome of inappropriate antidiuretic hormone (SIADH) secretion
• Wilson disease

Other reasons this test may be performed include:

• Chronic gouty arthritis
• Chronic kidney disease
• Injury of the kidney and ureter

Low levels of uric acid in the blood are seen much less commonly than high levels and are seldom considered cause for concern. Although low values can be associated with some kinds of liver or kidney diseases, Fanconi syndrome, exposure to toxic compounds, and rarely as the result of an inherited metabolic defect (e.g., Wilson disease), these conditions are typically identified by other tests and symptoms and not by an isolated low uric acid result.

Urine uric acid levels

A high uric acid level in the urine may be due to:

• Body not being able to process purine (Lesch-Nyhan syndrome)
• Certain cancers that have spread (metastatic cancer)
• Multiple myeloma
• Leukemia
• Disease that results in breakdown of muscle fibers (rhabdomyolysis)
• Disorders that affect the bone marrow (myeloproliferative disorder)
• Fanconi syndrome
• Gout
• High-purine diet

Those at risk of kidney stones who have high uric acid levels in their urine may be given medication to prevent stone formation.

A low uric acid level in the urine may be due to:

• Kidney that is not able to get rid of uric acid well, which can lead to gout or kidney damage
• Kidneys that are not able to filter fluids and waste normally (chronic glomerulonephritis)
• Lead poisoning
• Long-term (chronic) alcohol use

High uric acid levels

A high uric acid level or hyperuricemia, is an excess of uric acid in your blood. Uric acid is produced during the breakdown of purines, which are found in certain foods and are also formed by your body.

Once produced, uric acid is carried in your blood and passes through your kidneys, where most of it is filtered out into the urine. About one in five people has a high uric acid level. It may be related to attacks of gout or the development of kidney stones. But most people with high uric acid levels don’t have any symptoms or related problems.

Having a high uric acid level is not a disease or a condition that necessarily needs to be treated or searched for in the absence of other symptoms. But if you have an attack of gout or have a certain type of kidney stone, your doctor may check for high levels of uric acid.

Not everyone who has high uric acid gets gout. High levels of uric acid in the blood do not always lead to symptoms. This condition, called asymptomatic hyperuricemia, is fairly common. It is generally thought that this condition does not require any follow up or treatment unless the affected person is at a high risk of complications. People with family members who have had gout, kidney stones or kidney disease due to hyperuricemia may receive treatment even though they are not experiencing symptoms.

Most of the time, a high uric acid level occurs when your kidneys don’t eliminate uric acid efficiently. Things that may cause this slow-down in the removal of uric acid include rich foods, being overweight, having diabetes, taking certain diuretics (sometimes called water pills) and drinking too much alcohol. Other less common causes are a diet high in purine-containing items or your body producing too much uric acid.

Factors that may cause a high uric acid level in your blood include:

• Diuretic medications (water pills)
• Drinking too much alcohol
• Genetics (inherited tendencies)
• Hypothyroidism (underactive thyroid)
• Immune-suppressing drugs
• Niacin, or vitamin B-3
• Obesity
• Psoriasis
• Purine-rich diet — liver, game meat, anchovies, sardines, gravy, dried beans and peas, mushrooms, and other foods
• Renal insufficiency — inability of the kidneys to filter waste
• Tumor lysis syndrome — a rapid release of cells into the blood caused by certain cancers or by chemotherapy for those cancers

Also, you may be monitored for high uric acid levels when undergoing chemotherapy or radiation treatment for cancer.

If you’re concerned that one of your medications may be causing your high uric acid level, talk with your doctor. In the meantime, continue taking your medications unless your doctor tells you otherwise.

Uric acid gout

Gout is a common and complex painful form of arthritis, occurs when high levels of uric acid in the blood cause crystals to form and accumulate around a joint. Gout causes swollen, red, hot and stiff joints.

Gout is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares.

Gout happens when uric acid builds up in your body. Uric acid comes from the breakdown of substances called purines. Purines are in your body’s tissues and in foods, such as liver, dried beans and peas, and anchovies. Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But sometimes uric acid can build up and form needle-like crystals. When they form in your joints, it is very painful. The crystals can also cause kidney stones.

Often, gout first attacks your big toe. It can also attack ankles, heels, knees, wrists, fingers, and elbows. At first, gout attacks usually get better in days. Eventually, attacks last longer and happen more often.

Not everyone who has high uric acid gets gout. High levels of uric acid in the blood do not always lead to symptoms. This condition, called asymptomatic hyperuricemia, is fairly common. It is generally thought that this condition does not require any follow up or treatment unless the affected person is at a high risk of complications. People with family members who have had gout, kidney stones or kidney disease due to hyperuricemia may receive treatment even though they are not experiencing symptoms.

You are more likely to get gout if you:

• Are a man, especially as they get older
• Have family member with gout
• Are overweight
• Drink alcohol, especially beer
• Eat too many foods rich in purines
• Women after the menopause
• People who take medicines such as diuretics (water tablets) for blood pressure, or have high levels of cholesterol

Gout can be hard to diagnose. Your doctor may take a sample of fluid from an inflamed joint to look for crystals. Having too much uric acid can lead to crystals forming around your joints and causing pain. You can treat gout with medicines.

Pseudogout has similar symptoms and is sometimes confused with gout. However, it is caused by calcium phosphate, not uric acid.

You might get an attack if you’re very stressed or have had an illness.

If you injure or bruise a joint and it’s more painful than you would expect after a minor bump, it could be an attack coming on.

Get treatment straightaway if you feel an attack coming on.

Symptoms of gout

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion. As gout progresses, you may not be able to move your joints normally.

Causes of gout

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.

Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Risk factors for gout

You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

• Diet. Eating a diet rich in meat and seafood and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
• Obesity. If you’re overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
• Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
• Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
• Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
• Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
• Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.

Complications of gout

People with gout can develop more-severe conditions, such as:

• Recurrent gout. Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
• Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi. Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
• Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Prevention of gout

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

• Drink plenty of fluids. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high-fructose corn syrup.
• Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
• Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
• Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
• Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

Diagnosis of gout

Tests to help diagnose gout may include:

• Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.
• Blood test. Your doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.
• X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.
• Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus. This technique is more widely used in Europe than in the United States.
• Dual energy CT scan. This type of imaging can detect the presence of urate crystals in a joint, even when it is not acutely inflamed. This test is not used routinely in clinical practice due to the expense and is not widely available.

Treatment for gout

Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.

Gout medications can be used to treat acute attacks and prevent future attacks. Medications can also reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits.

Medications to treat gout attacks – to reduce pain and swelling

Attacks of gout are usually treated with anti-inflammatory medicine like ibuprofen – it should start to work within 3 days.

Drugs used to treat acute attacks and prevent future attacks include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex). Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks. NSAIDs carry risks of stomach pain, bleeding and ulcers.
• Colchicine. Your doctor may recommend colchicine (Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain. The drug’s effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea, especially if taken in large doses. After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.
• Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be in pill form, or they can be injected into your joint. Corticosteroids are generally used only in people with gout who can’t take either NSAIDs or colchicine. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.

Other things you can do to help alleviate gout pain:

• rest and raise the limb
• don’t knock the joint or put pressure on it
• keep the joint cool – apply an ice pack, or a bag of frozen peas wrapped in a towel, for up to 20 minutes at a time
• drink lots of water (unless advised not to by your doctor)
• try to keep bedclothes off the affected joint at night

If the gout doesn’t improve after 3 to 4 days, you might be given steroids as tablets or an injection.

Treatment to prevent gout coming back

Gout can come back every few months or years. It can come back more often over time if not treated.

If you have frequent attacks or tests show you have a high level of uric acid in your blood, your doctor might prescribe medicine called allopurinol or febuxostat.

This is used to lower the levels of uric acid and needs to be taken in the long term.

It’s important to take uric-acid-lowering medicine regularly, even when you no longer have symptoms.

Medications to prevent gout complications

If you experience several gout attacks each year, or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body’s level of uric acid may be recommended. Options include:

• Medications that block uric acid production. Drugs called xanthine oxidase inhibitors (XOIs), including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood’s uric acid level and reduce your risk of gout. Side effects of allopurinol include a rash and low blood counts. Febuxostat side effects include rash, nausea and reduced liver function.
• Medication that improves uric acid removal. These drugs, called uricosurics, include probenecid (Probalan) and lesinurad (Zurampic). Uricosuric drugs improve your kidneys’ ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones. Lesinurad can be taken only along with an xanthine oxidase inhibitor (XOI).

Foods high in uric acid

Making lifestyle changes might mean you can stop or reduce further attacks. A gout diet may help decrease uric acid levels in the blood. While a gout diet is not a cure, it may lower the risk of recurring painful gout attacks and slow the progression of joint damage. Medication also is needed to manage pain and to lower levels of uric acid.

Some foods should be avoided, but not all foods with purines should be eliminated. And some foods should be included in your diet to control uric acid levels.

The purpose of a gout diet today is to address all factors related to disease risk and management. Above all, the goals are a healthy weight and healthy eating — a message that applies to lowering the risk of many diseases.

Following a gout diet can help limit uric acid production and increase its elimination. Although the diet isn’t likely to lower the uric acid concentration in your blood enough to treat your gout without medication, it may help decrease the number of attacks and limit their severity.

Following the gout diet, along with limiting your calories and getting regular exercise, can also improve your overall health by helping you achieve and maintain a healthy weight.

The gout diet is primarily the same as standard recommendations for healthy diets that emphasize vegetables, fruits, whole grains, low-fat dairy and moderate lean meat consumption. Therefore, there is generally no risk associated with the diet.

The general principles of a gout diet are essentially the same as recommendations for a balanced, healthy diet:

Avoid

• eating a lot of red meat, kidneys, liver or seafood
• drink more than 14 units of alcohol a week
• eating sugary drinks and snacks
• eating full-fat dairy products
• eating more than 2 servings of low-fat dairy foods a day

Proteins. Limit daily proteins from lean meat, fish and poultry to 4 to 6 ounces (113 to 170 grams). Add protein to your diet with low-fat or fat-free dairy products, such as low-fat yogurt or skim milk, which are associated with reduced uric acid levels.

Complex carbs. Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods such as white bread, cakes, candy, sugar-sweetened beverages and products with high-fructose corn syrup.

Water. Keep yourself hydrated by drinking water. An increase in water consumption has been linked to fewer gout attacks. Aim for eight to 16 glasses of fluids a day with at least half of that as water. A glass is 8 ounces (237 milliliters). Talk to your doctor about appropriate fluid intake goals for you.

Fats. Cut back on saturated fats from red meats, fatty poultry and high-fat dairy products.

Recommendations for specific foods or supplements include the following:

• High-purine vegetables. Studies have shown that vegetables high in purines do not increase the risk of gout or recurring gout attacks. A healthy diet based on lots of fruits and vegetables can include high-purine vegetables, such as asparagus, spinach, peas, cauliflower or mushrooms. You can also eat beans or lentils, which are moderately high in purines but are also a good source of protein.
• Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
• Selected seafood. Avoid the following types of seafood, which are higher in purines than others: anchovies, herring, sardines, mussels, scallops, trout, haddock, mackerel and tuna.
• Alcohol. The metabolism of alcohol in your body is thought to increase uric acid production, and alcohol contributes to dehydration. Beer is associated with an increased risk of gout and recurring attacks, as are distilled liquors to some extent. The effect of wine is not as well-understood. If you drink alcohol, talk to your doctor about what is appropriate for you.
• Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan. Talk to your doctor about what a reasonable dose of vitamin C may be. And don’t forget that you can increase your vitamin C intake by eating more vegetables and fruits, especially oranges.
• Coffee. Some research suggests that moderate coffee consumption may be associated with a reduced risk of gout, particularly with regular caffeinated coffee. The available evidence isn’t enough to encourage noncoffee drinkers to start, but it may give researchers clues to new ways of treating gout in the future. Plus drinking coffee may not be appropriate for other medical conditions. Talk to your doctor about how much coffee is right for you.
• Cherries. There is some evidence that eating cherries is associated with a reduced risk of gout attacks. However, more research needs to be done to confirm this. Eating more cherries and drinking cherry extract may be a safe way to supplement your gout treatment, but discuss it with your doctor first.

Healthy lifestyle

Maintaining a healthy lifestyle is important when you have arthritis – it will help you manage your condition and stop it getting worse. By eating a varied diet, taking the right amount of exercise, and maintaining a healthy weight, you should be able to enjoy generally good health.

Weight loss and achieving a healthy body weight

Being overweight increases your risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lowers uric acid levels and reduces the number of gout attacks. Losing weight also lessens the overall stress on joints.

Achieving and maintaining a healthy weight is one of the most effective things you can do to reduce the symptoms of arthritis, particularly osteoarthritis. Just losing a small amount of weight can reduce strain on your back or in the joints of your legs. Making sure you are not underweight will help give your body the strength needed to get through a flare-up.

There are many different guides to determining if a person’s weight is considered to be within a healthy range. One of most commonly used indicators is the body mass index (BMI).

Controlling calorie intake

A reasonably active woman needs an intake of around 2,000 calories per day, and a reasonably active man needs around 2,500 calories. But these are average guidelines; every individual has unique nutritional requirements, depending on age, gender, body size and level of activity.

Exercise

People with arthritis benefit from three types of exercise:

• Stretching exercises – to ease joint pain and improve joint movement
• Strengthening exercises – to keep your muscles strong, which will help relieve stress and pain in your joints (such as Pilates)
• Aerobic exercises – to achieve and maintain general fitness (such as walking, cycling or general fitness classes).