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Urate-lowering therapy for asymptomatic hyperuricaemia: A need for caution
1Department of Medicine, University of Otago, Christchurch, 2 Riccarton Ave, P.O. Box 4345, Christchurch, New Zealand.
Insights
Treating asymptomatic hyperuricaemia is premature due to unclear causal roles and potential adverse effects. More evidence is needed before widespread treatment for non-gout diseases.
Area of Science:
- Nephrology
- Cardiology
- Rheumatology
Background:
- Hyperuricemia is increasingly associated with hypertension, cardiovascular disease, and kidney disease.
- The potential benefit of urate-lowering therapy for these non-gout diseases is under investigation.
- Current recommendations for urate-lowering therapy vary by country.
Purpose of the Study:
- To discuss the complexities and current limitations in treating asymptomatic hyperuricemia.
- To evaluate the evidence regarding the causal role of urate in non-gout diseases.
- To assess the risks and benefits of urate-lowering therapies.
Main Methods:
- A literature search was conducted using PubMed with the term "asymptomatic hyperuricaemia" in January 2016.
Main Results:
- There is no consistent definition for hyperuricemia or asymptomatic hyperuricemia.
- The causal role of urate in non-gout diseases remains largely unknown.
- Evidence on the effects of urate lowering on disease progression is lacking.
- Urate-lowering therapies carry potential risks, including allopurinol hypersensitivity syndrome.
Conclusions:
- Treating asymptomatic hyperuricemia appears premature given the current lack of evidence.
- Further research is required to clarify the role of urate and the efficacy/safety of urate-lowering therapies.
Objective:
The observed associations of hyperuricaemia with hypertension, cardiovascular disease and kidney disease are receiving increasing interest. The potential role of urate-lowering therapy in the management of these "non-gout diseases" has been raised, and in some countries it is already recommended. However, there is no consistent definition of hyperuricaemia or asymptomatic hyperuricaemia, much remains unknown about the causal role of urate in these "non-gout diseases" and there is currently a lack of evidence about the effects of urate lowering on disease progression. In addition, there is potential for serious adverse effects associated with urate-lowering therapies with recent evidence suggesting that asymptomatic hyperuricaemia may be an independent risk factor for the potentially fatal allopurinol hypersensitivity syndrome.
Methods:
Pubmed was searched in January 2016 using the search term "asymptomatic hyperuricaemia".
Results And Conclusions:
Herein, we discuss the issues related to treating asymptomatic hyperuricaemia, which at present seems premature.
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