PERT Does Not Cause Gout Flare-Ups
Pancreatic enzyme replacement therapy (PERT) is not associated with causing gout flare-ups. There is no evidence in the medical literature linking PERT to gout exacerbations or hyperuricemia.
Why This Question Arises
This question likely stems from confusion between two entirely different therapeutic contexts:
- PERT is used for exocrine pancreatic insufficiency (primarily in cystic fibrosis and chronic pancreatitis) to aid digestion by replacing deficient pancreatic enzymes 1, 2
- Gout management involves urate-lowering therapy (ULT) such as allopurinol or febuxostat, which can paradoxically trigger flares when initiated 3, 4
What Actually Causes Gout Flares
Initiation of Urate-Lowering Therapy
- Starting ULT (not PERT) frequently causes gout flares in the first 6 months due to mobilization of urate crystals from tissue deposits 4
- This occurs because rapid lowering of serum urate levels leads to crystal shedding from tophi, triggering acute inflammatory responses 4
- The rate of acute gout flares approximately doubles when anti-inflammatory prophylaxis is discontinued after 8 weeks of ULT 3, 4
Prevention Strategy for ULT-Related Flares
- Prophylaxis with low-dose colchicine or NSAIDs should always be provided when initiating ULT to prevent acute flares, continued for more than 8 weeks 3, 5
- High-quality evidence supports that prophylactic therapy significantly reduces the risk of gout attacks when starting urate-lowering therapy 4
PERT Safety Profile
The adverse events associated with PERT are primarily gastrointestinal:
- Meta-analysis of PERT trials showed no significant increase in adverse events compared to placebo 2
- Common side effects include gastrointestinal symptoms, but gout or hyperuricemia are not reported complications 1, 2
Clinical Pitfall to Avoid
Do not confuse PERT with ULT. If a patient with both pancreatic insufficiency and gout experiences flares after starting new medication, investigate whether they recently initiated allopurinol, febuxostat, or other urate-lowering agents—not their pancreatic enzymes 5, 3.