From the FDA Drug Label
Hyperuricemia may be primary, as in gout, or secondary to diseases such as acute and chronic leukemia, polycythemia vera, multiple myeloma, and psoriasis It may occur with the use of diuretic agents, during renal dialysis, in the presence of renal damage, during starvation or reducing diets, and in the treatment of neoplastic disease where rapid resolution of tissue masses may occur.
The causes of gout in a patient with cancer include:
- Secondary hyperuricemia due to the cancer itself, such as acute and chronic leukemia, polycythemia vera, and multiple myeloma
- Rapid cell lysis during chemotherapy, leading to increased uric acid production 1
- Treatment of neoplastic disease, where rapid resolution of tissue masses may occur, resulting in increased uric acid levels 1
From the Research
Gout in cancer patients is primarily caused by factors related to the cancer itself, such as high cell turnover, and its treatments, including chemotherapy, radiation therapy, and certain medications. The most recent and highest quality study, 2, found that patients with chronic tophaceous gout have a significantly higher risk of developing colorectal cancer, with an odds ratio of 1.40. This study suggests that the relationship between gout and cancer is complex and multifactorial. Other factors that contribute to the development of gout in cancer patients include:
- High cell turnover from certain cancers, especially blood cancers like leukemia and lymphoma, which releases large amounts of purines that convert to uric acid, leading to hyperuricemia and gout
- Cancer treatments such as chemotherapy and radiation therapy, which can cause tumor lysis syndrome, where rapid destruction of cancer cells floods the bloodstream with purines
- Certain medications used in cancer care, including diuretics, cyclosporine, and low-dose aspirin, which can raise uric acid levels
- Dehydration, which is common during cancer treatment, reduces uric acid excretion
- Kidney dysfunction from cancer or its treatments, which impairs uric acid elimination
- Dietary changes that may include high-purine foods, and reduced physical activity during treatment, which can slow metabolism and uric acid clearance. Management of gout in cancer patients typically involves medications such as allopurinol or febuxostat to prevent attacks, along with colchicine, NSAIDs, or corticosteroids for acute flares, carefully selected based on the patient's specific cancer treatment regimen and organ function, as supported by 3, 4, and 5.