What is the best approach to educate a patient with hyperuricemia (elevated uric acid levels)?

Patient Education for High Uric Acid

Educate patients that hyperuricemia requires lifelong management focused on achieving and maintaining a serum uric acid level below 6 mg/dL through diet modification, lifestyle changes, and medication adherence to prevent gout attacks, kidney damage, and cardiovascular complications. 1, 2

Understanding the Disease and Its Consequences

Explain to patients that uric acid becomes supersaturated and forms crystals when levels exceed 6.8 mg/dL, which triggers gout attacks and can damage multiple organs 2. Emphasize that:

• Maintaining uric acid below 6.0 mg/dL reduces gout attack risk to approximately 5% at one year, compared to 10-15% risk when levels remain at or above 6.0 mg/dL 2
• Hyperuricemia increases chronic kidney disease risk (4% versus 2% at year 1, and 9% versus 5% at year 3 in high versus low uric acid groups) 2
• High uric acid independently associates with hypertension, coronary heart disease, heart failure, stroke, peripheral arterial disease, and cardiovascular mortality 2, 3
• Without treatment, gout progresses from acute episodic arthritis to chronic arthritis affecting multiple joints, with tophi developing in joints, tissues, bone, ears, and skin 2

Dietary Modifications

Instruct patients to make specific dietary changes 1, 2, 4:

Foods to Limit:

• Purine-rich meats (beef, pork, lamb) and seafood (shellfish, anchovies, sardines) 1
• High-fructose corn syrup sweetened beverages 1, 2

Foods to Avoid:

• All alcohol, especially beer and spirits (beer increases risk by 1.49 per serving per day, spirits by 1.15 per serving per day) 1
• Wine consumption does not significantly increase uric acid levels but should still be limited 1

Foods to Encourage:

• Low-fat or non-fat dairy products (inversely associated with uric acid levels) 1
• Vegetables 1, 4

Lifestyle Changes

Counsel patients on weight management, as successful weight loss reduces serum uric acid from approximately 570 mmol/L to 470 mmol/L within 16 weeks 1. Address obesity as part of comprehensive management since it associates with metabolic syndrome and cardiovascular risk 1.

Medication Review and Comorbidity Management

Educate patients that certain medications elevate uric acid and should be eliminated if not essential 1, 2:

• Thiazide and loop diuretics 1, 2, 4
• Niacin 1, 2
• Calcineurin inhibitors 1, 2

Do not discontinue low-dose aspirin (≤325 mg daily) for cardiovascular prophylaxis, as its modest effect on uric acid is negligible compared to cardiovascular benefits 1.

Explain that associated conditions require screening and management 1:

• Hyperlipidemia, hypertension, diabetes, obesity, and smoking 1
• Some treatments for these conditions (losartan for blood pressure, fenofibrate for lipids) also lower uric acid 1

Urate-Lowering Therapy Education

Inform patients that medication is lifelong treatment, not temporary 2, 4. Explain the treatment approach:

Starting Therapy:

• Allopurinol begins at 100 mg daily and increases by 100 mg every 2-4 weeks until target is achieved 2, 5
• The medication works by blocking uric acid formation rather than increasing kidney excretion 5
• Effects manifest within 2-3 days, with full effects after one week or more 5

Flare Prophylaxis:

• All patients require prophylaxis for the first 6 months when starting urate-lowering therapy 2
• Colchicine 0.5-1 mg daily is first choice, with low-dose NSAIDs as alternative 2
• Explain that gout attacks may initially increase as crystals dissolve, which is why prophylaxis is essential 2

Monitoring and Long-Term Management

Educate patients on the monitoring schedule 2:

• Serum uric acid checked every 2-4 weeks during dose adjustment 2
• Once stable at target, regular monitoring continues to ensure maintenance 2
• Treatment continues indefinitely as this is lifelong therapy 2

For severe disease with tophi, target serum uric acid below 5 mg/dL until complete crystal dissolution 2.

When to Seek Specialist Care

Inform patients to request rheumatology referral if 1, 4:

• Unclear cause of high uric acid 1, 4
• Symptoms persist despite treatment 1, 4
• Difficulty reaching target uric acid level, particularly with kidney impairment 1, 4
• Multiple or serious side effects from medications 1, 4

Special Screening Situations

Explain that 24-hour urine uric acid testing is needed for patients with 1, 2, 4:

• Gout onset before age 25 1, 2, 4
• History of kidney stones 1, 2, 4

This screens for uric acid overproduction requiring different management approaches 1, 2.