asymptomatic raised or high uric acid

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  • a raised blood urate (hyperuricaemia) with no symptoms does not mean a patient will inevitably develop gout
  • risk factors for the development of gout should be looked for e.g. drug-induced causes, increased cell turnover (e.g. lymphoma), reduced excretion
    • modification of factors such as diet/therapy should be undertaken if need be (1)
      • regarding thiazides and asymptomatic hyperuricaemia (2)
        • occurs in up to 30% of hypertensive patients treated with thiazide diuretics
        • the presence of hyperuricaemia per se does not require withdrawal of the thiazide or treatment
        • if gout develops however then it is prudent to stop thiazide treatment and initiate alternative therapy for hypertension
        • if a patient has a history of gout then treatment with thiazides are best not used - if necessary concurrent treatment with allopurinol can allow continued treatment with a thiazide
    • raised uric acid is associated with other factors such as hypertension, dehydration, hyperlipidaemia
    • there is also a theoretical risk of hyperuricaemia with low carbohydrate diets, due to higher protein content
  • drug therapy for asymptomatic hyperuricaemia is not indicated unless there are concerns regarding uric acid stones e.g. in renal failure
    • "..hyperuricaemia, in the absence of gout, does not require treatment unless it is accompanied by other, extra-arthritic, complications such as uric acid nephropathy or urolithiasis.." (3)

Reference:

  1. Pulse (2004), 64 (12), 96.
  2. Prescriber (2001), 12 (18), 49-61.
  3. Drug and Therapeutics Bulletin (2004); 42(5):37-40.

Last reviewed 01/2018

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