Asymptomatic raised or high uric acid

• 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.