Can Rosuvastatin (Crestor) Cause Gout Flares?
Rosuvastatin does not directly cause gout flares and is not listed among medications known to precipitate acute gout attacks. The evidence shows no established mechanism linking statins to gout precipitation, and rosuvastatin is not mentioned in major gout management guidelines as a trigger for flares.
Medications That Actually Precipitate Gout
The established culprits for triggering gout flares include:
- Diuretics (loop and thiazide) are strongly associated with increased gout risk and can precipitate acute attacks 1, 2
- Pyrazinamide (tuberculosis medication) causes asymptomatic hyperuricemia as an expected effect and can trigger acute gouty arthritis, particularly in patients with preexisting gout 1
- Cyclosporine increases gout risk and is specifically mentioned as requiring xanthine oxidase inhibitors as first-line urate-lowering therapy 3
Rosuvastatin's Safety Profile
The comprehensive safety data on rosuvastatin from over 10,000 patients shows:
- Common adverse effects include myopathy, rhabdomyolysis (rare), liver enzyme elevations, gastrointestinal symptoms, and CNS effects—but gout or hyperuricemia are not listed 4, 5
- Renal effects include proteinuria and rare renal failure at higher doses, but these are related to tubular protein reabsorption inhibition, not uric acid metabolism 5
- No interaction with uric acid metabolism is documented in the pharmacology literature 4, 5
Clinical Context: Distinguishing Correlation from Causation
If a patient on rosuvastatin experiences a gout flare, consider these more likely explanations:
- Concurrent diuretic use for hypertension or heart failure (common in patients requiring statins) 2
- Metabolic syndrome components frequently coexist with both dyslipidemia requiring statins and gout 2
- Dehydration, surgery, or acute illness are known gout precipitants 2
- Natural disease progression in patients with underlying hyperuricemia 6
Practical Recommendation
Continue rosuvastatin if a patient develops gout. There is no evidence-based reason to discontinue statin therapy when gout occurs. Instead:
- Treat the acute gout flare with NSAIDs, corticosteroids, or colchicine per standard protocols 1, 7
- Evaluate for actual gout triggers: diuretics, alcohol intake, purine-rich diet, dehydration 6, 2
- Consider urate-lowering therapy if the patient meets criteria (≥2 flares/year, tophi, radiographic damage, or CKD stage ≥3) 6, 8
- Do not attribute the gout flare to rosuvastatin without evidence of other causative factors 4, 5