From the Guidelines
Asymptomatic hyperuricemia does not require treatment with uric acid-lowering medications, and lifestyle modifications are the recommended first approach. This is based on the recommendation from the multinational evidence-based recommendations for the diagnosis and management of gout, which states that pharmacological treatment of asymptomatic hyperuricaemia is not recommended to prevent gouty arthritis, renal disease or CV events 1. The guidelines suggest that treatment is typically reserved for patients who have experienced gout attacks, kidney stones, or have certain specific conditions.
Some key lifestyle modifications that can help manage asymptomatic hyperuricemia include:
- Maintaining a healthy weight
- Limiting alcohol consumption (especially beer)
- Reducing intake of purine-rich foods (like red meat, seafood, and organ meats)
- Staying well-hydrated
- Avoiding high-fructose corn syrup
Medications like allopurinol, febuxostat, or probenecid are usually only initiated when patients have had gout attacks, tophi, uric acid kidney stones, or very high uric acid levels with comorbidities like chronic kidney disease 1. This approach is taken because the medications carry risks of side effects, and many people with asymptomatic hyperuricemia never develop gout or complications. The risk-benefit ratio doesn't favor medication use in asymptomatic cases, as only about 10-20% of people with hyperuricemia will develop gout over their lifetime.
It's also important to note that the American College of Rheumatology guidelines for management of gout also do not address pharmacologic management of asymptomatic hyperuricemia due to a paucity of prospective, randomized, controlled human research trials in that area 1. Therefore, the focus should be on lifestyle modifications and monitoring for symptoms or complications, rather than initiating medication for asymptomatic hyperuricemia.
From the FDA Drug Label
Asymptomatic hyperuricemia is not an indication for treatment with allopurinol tablets (see INDICATIONS AND USAGE) KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.
No, you do not treat hyperuricemia without gout symptoms. According to the drug labels of allopurinol 2 and pegloticase 3, asymptomatic hyperuricemia is not an indication for treatment with these medications.
From the Research
Treatment of Hyperuricemia without Gout Symptoms
- The treatment of asymptomatic hyperuricemia is a topic of debate, with some studies suggesting that it may be useful to treat it to decrease the risk of cardiovascular complications 4.
- However, the evidence is not unanimous, and more research is needed to determine the best course of treatment 4.
- Some studies have investigated the use of medications such as febuxostat and allopurinol to treat hyperuricemia, with mixed results 5, 6.
- Lifestyle changes, such as weight reduction, exercise, and dietary modifications, may also be beneficial in managing hyperuricemia and reducing the risk of gout and cardiovascular complications 7.
Medications for Hyperuricemia
- Febuxostat is a nonpurine xanthine oxidase inhibitor that has been shown to be effective in reducing serum urate levels in patients with hyperuricemia and gout 5.
- Allopurinol is another xanthine oxidase inhibitor that is commonly used to treat hyperuricemia and gout, but it may not be suitable for all patients due to potential side effects and interactions 5, 6.
- Other medications, such as lesinurad and arhalofenate, are also being developed and investigated for the treatment of hyperuricemia and gout 8.
Lifestyle Modifications
- Weight reduction and exercise may help to reduce serum urate levels and decrease the risk of gout and cardiovascular complications 7.
- Dietary modifications, such as reducing intake of purine-rich foods and increasing consumption of dairy products and fruits, may also be beneficial 7.
- Avoiding heavy alcohol drinking and dehydration may also help to reduce the risk of gout and hyperuricemia 7.