From the Guidelines
Hyperuricemia should be treated in patients with symptomatic gout, kidney stones, or urate nephropathy, as well as in those with asymptomatic hyperuricemia who have a history of urolithiasis, moderate-to-severe chronic kidney disease (CKD), or serum urate concentrations >9 mg/dL. The indications for treating hyperuricemia include:
- Symptomatic gout, defined as gout with frequent flares (≥2 annually), radiographic damage, or presence of subcutaneous tophi 1
- Asymptomatic hyperuricemia with comorbid conditions such as urolithiasis, moderate-to-severe CKD, or serum urate concentrations >9 mg/dL 1
- Patients with a history of kidney stones, as urate-lowering therapy can reduce the risk of recurrent stone formation 1 The treatment approach should prioritize urate-lowering therapy (ULT) with medications such as allopurinol or febuxostat, and lifestyle modifications including weight loss, limiting alcohol intake, and reducing consumption of purine-rich foods 1. Key considerations in the management of hyperuricemia include:
- Initiating ULT in patients with symptomatic gout or asymptomatic hyperuricemia with high-risk comorbid conditions 1
- Using allopurinol as the first-line medication for chronic hyperuricemia, with febuxostat as an alternative for patients who cannot tolerate allopurinol 1
- Implementing lifestyle modifications to accompany medication therapy and promote overall health 1
From the FDA Drug Label
INDICATIONS AND USAGE Probenecid tablets are indicated for the treatment of the hyperuricemia associated with gout and gouty arthritis. Allopurinol tablets are indicated in: the management of patients with signs and symptoms of primary or secondary gout (acute attacks, tophi, joint destruction, uric acid lithiasis, and/or nephropathy). KRYSTEXXA® (pegloticase) is a PEGylated uric acid specific enzyme indicated for the treatment of chronic gout in adult patients refractory to conventional therapy.
The indications for treating hyperuricemia are:
- Gout and gouty arthritis with probenecid 2
- Primary or secondary gout with allopurinol 3
- Chronic gout in adult patients refractory to conventional therapy with pegloticase 4 Note that asymptomatic hyperuricemia is not recommended for treatment with sulfinpyrazone, allopurinol, or pegloticase.
From the Research
Indications for Treating Hyperuricemia
- Hyperuricemia is often associated with conditions such as gout, metabolic syndrome, hypertension, and chronic kidney disease (CKD) 5, 6, 7, 8, 9
- The decision to treat hyperuricemia depends on various factors, including the presence of symptoms, the level of uric acid, and the presence of comorbidities 5, 6, 7, 8, 9
- Symptomatic hyperuricemia, such as gout, is typically treated with urate-lowering therapy (ULT) and anti-inflammatory medications 5, 7
- Asymptomatic hyperuricemia is a more complex condition, and the benefits of treatment are still uncertain 5, 6, 7, 8
Treatment Approaches
- Lifestyle interventions, such as exercise, weight reduction, and dietary changes, are recommended for all hyperuricemic patients 6, 7
- Urate-lowering agents, such as allopurinol and febuxostat, may be considered in certain cases, but their use is not universally recommended 5, 6, 7, 9
- The use of urate-lowering therapy in asymptomatic hyperuricemia associated with cardiovascular diseases is not clearly beneficial, and guideline-recommended therapies for cardiovascular diseases may be more effective in reducing uric acid levels and cardiovascular events 7
Special Considerations
- In patients with CKD, hyperuricemia may contribute to the progression of kidney disease, and urate-lowering therapy may be considered to prevent or delay the decline of renal function 6, 9
- The role of uric acid in cardiovascular disease is still uncertain, and further research is needed to determine whether elevated uric acid is a causal agent and a potential therapeutic target 7, 8