Hyperuricemia Treatment & Management: Medical Care, Consultations, Diet (2022)

Asymptomatic hyperuricemia

Most patients with asymptomatic hyperuricemia never develop gout or stones. Pharmacologic treatment for asymptomatic hyperuricemia carries some risk, is not considered beneficial or cost-effective, and generally is not recommended. However, these patients can be advised on lifestyle changes such as changes in diet, reduction in alcohol intake, and exercise, which may lower uric acid levels. [35] The exception to this is in an oncologic setting, in which patients receiving cytolytic treatment may receive prophylaxis against acute uric acid nephropathy.

In addition to avoiding foods that are high in purines, dietary measures may include ensuring adequate magnestium and zinc intake, as higher intake is associated with decreased hyperuricemia risk. [14, 15] Use of probiotics (eg, Bifidobacteria,Lactobacilli) may promote purine and uric acid catabolism by the gut microbiota. [36, 37]

Symptomatic hyperuricemia

The clinical scenarios under which hyperuricemia can be symptomatic are gout, uric acid stones, or uric acid nephropathy.

Acute gouty arthritis

The initial goal in acute gouty arthritis is to provide symptomatic relief from pain. Indomethacin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs of choice. NSAIDs are prescribed for approximately a 7- to 10-day course or until 3-4 days after all signs of inflammation have resolved. Use NSAIDs with caution or avoid them in patients in edematous states, such as heart failure, and in patients with peptic ulcer disease or kidney insufficiency.

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Colchicine, which inhibits neutrophil activation, is effective but is currently used less frequently because of its adverse effects. Traditionally, colchicine is administered as a 0.6-mg dose every hour until improvement occurs, adverse gastrointestinal effects occur, or a total of 10 doses is reached and no relief is noted. The adverse gastrointestinal effects include abdominal pain, diarrhea, and nausea, which occur in most patients started on colchicine. Although colchicine can be administered intravenously, this is usually avoided because of its potential for serious toxicity.

Use intra-articular glucocorticoids in patients with contraindications to NSAID or colchicine use. Occasionally, intra-articular glucocorticoids may be used in patients with gouty arthritis refractory to NSAIDs or colchicine.

Chronic gout therapy

After the symptoms of acute gout subside, patients enter the intercritical period during which a decision must be made regarding the need for treatment with a urate-lowering medication. One important point to consider is that abrupt lowering of urate levels can precipitate an attack of acute gout during the intercritical period. Thus, these patients should receive prophylactic colchicine coverage irrespective of which urate-lowering medication is used.

The choice of urate-lowering medications is uricosuric drugs (which promote uric acid excretion) or xanthine oxidase inhibitors (which inhibit uric acid production).

Probenecid, which is a uricosuric drug, inhibits the tubular reabsorption of filtered and secreted urate, thereby increasing urate excretion. The ideal candidates for probenecid therapy are those with a 24-hour urine uric acid excretion of less than 800 mg, no history of nephrolithiasis, and good kidney function (creatinine clearance >80 mL/min). The starting dose for probenecid is 250 mg twice a day, which can be increased gradually to a maximum daily dose of 3 g/d. Some degree of gastrointestinal irritation is experienced by approximately 2% of patients.

Allopurinol is the most widely used antihyperuricemic agent. The major metabolite of allopurinol is oxypurinol, and both allopurinol and oxypurinol are competitive inhibitors of the enzyme xanthine oxidase.

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The ideal candidates for allopurinol treatment are as follows:

Although allopurinol can be used in almost any hyperuricemic state, the above-mentioned conditions are more specific indications for allopurinol use. The usual maintenance dose for adults is 200-300 mg/d. The long half-life of oxypurinol makes once-daily dosing possible. Very importantly, adjust the dose in persons with chronic kidney disease because a higher incidence of adverse effects is observed if the dose is not adjusted.

Allopurinol is well tolerated by most patients, but hypersensitivity reactions may develop, which can be severe or fatal. Because a skin rash may progress to a severe hypersensitivity reaction, patients who develop a skin rash should discontinue allopurinol. Hepatotoxicity, bone marrow depression, and interstitial nephritis are rare but serious adverse effects of allopurinol.

Febuxostat is an orally administered xanthine oxidase inhibitor that was approved by the US Food and Drug Administration (FDA) in 2009 for the long-term treatment of hyperuricemia in patients with gout. In the CONFIRMS trial, a 6-month study that compared febuxostat and allopurinol in 2269 subjects with gout and serum urate levels ≥8.0 mg/dL, febuxostat 80 mg daily proved superior to allopurinol in lowering uric acid levels in patients with normal renal function,and febuxostat 40 mg daily was equivalent to allopurinol in such patients. In patients with mild-to-moderate renal impairment, febuxostat at any dose was superior to allopurinol in lowering uric acid levels. [38]

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Overall, febuxostat was as safe as allopurinol in the CONFIRMS trial. [38] However, previous studies have identified cardiovascular events with febuxostat, and large ongoing trials are comparing the cardiovascular safety of febuxostat versus allopurinol. [39]

Lesinurad (Zurampic) is the first selective uric acid reabsorption inhibitor (SURI) approved by the FDA. It acts by inhibiting the urate transporter, URAT1, which is responsible for the majority of the renal reabsorption of uric acid. It also inhibits organic anion transporter 4 (OAT4), a uric acid transporter associated with diuretic-induced hyperuricemia.

Lesinurad must be coadministered with a xanthine oxidase inhibitor and is indicated for hyperuricemia associated with gout in patients who have not achieved target serum uric acid levels with a xanthine oxidase inhibitor alone. It is not approved for asymptomatic hyperuricemia and it is contraindicated for increased uric acid levels caused by tumor lysis syndrome or Lesch-Nyhan syndrome.

Monotherapy or higher than recommended doses are associated with an increased serum creatinine level. Kidney function should be assessed before initiating therapy and periodically thereafter. More frequent monitoring is required for an estimated creatinine clearance (CrCl) below 60 mL/min. Do not initiate therapy if the CrCl is below 45 mL/min and discontinue if CrCl decreases persistently to below 45 mL/min.

Approval was based on three randomized, placebo-controlled studies involving 1537 participants for up to 12 months. Serum uric acid levels were lower in participants treated with lesinurad plus allopurinol or febuxostat than in those who received placebo in combination with a xanthine oxidase inhibitor. [40]

Pegloticase (Krystexxa) is a recombinant, pegylated, uric acid–specific enzyme that catalyzes the oxidation of uric acid to allantoin. It is approved for use in adults with chronic gout that is refractory to conventional therapy. It is administered by intravenous infusion.

Uric acid nephrolithiasis

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Allopurinol is the mainstay of drug therapy in patients with hyperuricemia who develop uric acid stones. Patients with calcium stones who are hyperuricosuric may also benefit from allopurinol because urate crystals in the urine may act as a nidus for other stones to form.

Potassium citrate and occasionally sodium bicarbonate or acetazolamide may be required to alkalinize the urine and to increase the solubility of uric acid.

Adequate hydration is recommended to maintain a high urine output of at least 2 L daily, unless otherwise contraindicated for other medical conditions where volume overload may be a concern.

Uric acid nephropathy

Over the years, efforts to prevent uric acid nephropathy, especially in the oncological setting, have resulted in a decrease in mortality from uric acid nephropathy. Intravenous hydration with saline and the administration of furosemide or mannitol (to dilute the urine) are necessary to prevent further precipitation of uric acid. Alkalinizing the urine with sodium bicarbonate or acetazolamide may be necessary to further enhance uric acid elimination.

Rasburicase (Elitek), a recombinant urate oxidase, is approved for use in preventing complications of hyperuricemia during the tumor lysis syndrome in both adults and children. It facilitates the conversion of urate to a more soluble product, allantoin. Although rasburicase treatment has become the standard of care for patients at high risk of tumor lysis syndrome, debate continues on whether the profound and rapid lowering of plasma uric acid levels produced by rasburicase has a significant effect on patient outcomes (eg, need for renal replacement therapy and mortality). [41]

Higher doses than usual of rasburicase (600-900 mg/d) are administered to decrease uric acid production prior to chemotherapy in patients with leukemias and lymphomas; allopurinol and hydration are continued for several days. If acute kidney injury develops despite these measures, then early hemodialysis is indicated to reduce the total body burden of uric acid, thereby facilitating recovery of kidney function.

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FAQs

What is treatment of hyperuricemia? ›

Allopurinol is the mainstay of drug therapy in patients with hyperuricemia who develop uric acid stones. Patients with calcium stones who are hyperuricosuric may also benefit from allopurinol because urate crystals in the urine may act as a nidus for other stones to form.

Which is the first line treatment for chronic hyperuricemia? ›

Xanthine oxidase inhibitors (XOIs) still remain the first line of treatment as recommended by all guidelines. Among these, allopurinol is the first-line agent in all but the ACR guidelines, which recommend allopurinol or febuxostat interchangeably.

What foods are high in uric acid? ›

Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid. Red meat. Limit serving sizes of beef, lamb and pork. Seafood.

What are the main treatment strategies used in the management of gout? ›

Treatment of gout involves managing hyperuricemia with urate-lowering therapy (i.e., diet, lifestyle, pharmacologic agents) and of acute gouty arthritis with colchicine, nonsteroidal anti-inflammatory drugs, and/or corticosteroids.

Can we eat egg in hyperuricemia? ›

Certain foods, such as red meat, are rich in purines. You should avoid such foods if you have gout or are at a high risk for it. This means you need to choose sources of protein that are low in purines. Eggs are a good option.

How do you prevent hyperuricemia? ›

This article reviews natural ways to help lower uric acid levels.
  1. Limit purine-rich foods. ...
  2. Eat more low purine foods. ...
  3. Avoid medications that raise uric acid levels. ...
  4. Maintain a healthy body weight. ...
  5. Avoid alcohol and sugary drinks. ...
  6. Drink coffee. ...
  7. Try a vitamin C supplement. ...
  8. Eat cherries.
29 Jun 2022

What are the two main types of hyperuricemia? ›

Causes of high uric acid levels (hyperuricemia) can be primary (increased uric acid levels due to purine), and secondary (high uric acid levels due to another disease or condition). Sometimes, the body produces more uric acid than it is able to excrete.

What is the most common cause of hyperuricemia? ›

Most of the time, a high uric acid level occurs when your kidneys don't eliminate uric acid efficiently. Things that may cause this slow-down in the removal of uric acid include rich foods, being overweight, having diabetes, taking certain diuretics (sometimes called water pills) and drinking too much alcohol.

Which medication helps prevent hyperuricemia? ›

Allopurinol (Zyloprim, Prometheus), a potent purine xanthine oxidase (XO) inhibitor, is the most commonly used drug in the treatment of hyperuricemia.

Which fruit is best for uric acid? ›

Grapefruit, oranges, pineapples, and strawberries are all great sources of vitamin C, which lowers your uric acid levels and helps prevent gout attacks.

What is uric acid diet chart? ›

1 cup bajra upma with vegetables+1 glass milk/1 cup tea(toned) Mid-Meal (11:00-11:30AM) 100gm musk melon. Lunch (2:00-2:30PM) 1 cup brown rice+2 jowar roti+1/2 cup snake gourd sabji+1/2 cup rasam+1 glass buttermilk.

Which vegetables are good for uric acid? ›

Oats, whole grains, vegetables like broccoli, pumpkin and celery should be included in the diet to lower the uric acid level. These types of foods are filled with dietary fibres that are extremely beneficial in the absorption of the uric acid and in eliminating it from the body.

What is the best medical treatment for gout? ›

Colchicine. Your doctor may recommend colchicine (Colcrys, Gloperba, Mitigare), an anti-inflammatory drug that effectively reduces gout pain.

What is the best vitamin for gout? ›

Rev up the Vitamin C

Some studies show that vitamin C can help lower uric acid levels in people who have gout, while a 2009 study showed that the more vitamin C men took, the less likely they were to get gout. Vitamin C is readily available in supplements as well as in common foods.

What is the fastest treatment for gout? ›

The Best Way to Treat a Gout Attack

Anti-inflammatory drugs like naproxen (which can be purchased over the counter or in prescription strength) Colchicine, which reduces uric acid build-up. Steroids, such as prednisone.

Can we eat chicken in uric acid? ›

So, Is Chicken Good for Uric Acid? Chicken can be a part of a healthy diet for people with uric acid levels, but it is important to choose lean cuts of chicken and remove the skin before cooking. Additionally, you should limit your intake of fried chicken or chicken that is high in saturated fat.

Is chicken Good for hyperuricemia? ›

Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day). Vegetables: You may see veggies like spinach and asparagus on the high-purine list, but studies show they don't raise your risk of gout or gout attacks.

Is banana good for uric acid? ›

Bananas are low in purines and high in vitamin C, which makes them a good food to eat if you have gout. Changing your diet to include more low-purine foods, like bananas, can lower the amount of uric acid in your blood and reduce your risk of recurrent gout attacks.

What disease causes hyperuricemia? ›

Acidosis: Types that cause hyperuricemia include lactic acidosis, diabetic ketoacidosis, alcoholic ketoacidosis, and starvation ketoacidosis.

What removes uric acid from the body? ›

Purines are also formed and broken down in your body. Normally, your body filters out uric acid through your kidneys and in urine.

Is hyperuricemia a kidney disease? ›

Hyperuricemia may be a major contributor to the development or progression of chronic kidney disease (CKD). Although there is no clear cutoff uric acid (UA) value associated to the risk for kidney damage, it appears to be an increased risk as UA rises.

What is alarming level of uric acid? ›

Generally, your uric acid level is high when: For females, it's over 6 mg/dL. For males, it's over 7 mg/dL.

Is lemon good for uric acid? ›

Lemon juice may help balance uric acid levels because it helps make the body more alkaline. This means it slightly raises the pH level of blood and other fluids. Lemon juice also makes your urine more alkaline.

Can hyperuricemia be cured? ›

It is possible to treat hyperuricemia through dietary changes. Consuming fewer foods and drinks that are high in purine can reduce uric acid in the blood. This reduction helps the kidneys to filter out uric acid more effectively again.

What are the three symptoms of uric acid? ›

They include:
  • Intense joint pain. Gout usually affects the big toe, but it can occur in any joint. ...
  • Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. ...
  • Inflammation and redness. ...
  • Limited range of motion.

Which vegetable has the most uric acid? ›

Vegetables that have high purine content include cauliflower, spinach, and mushrooms.

Is Apple good for uric? ›

The fructose amount stimulates uric acid production leading to worse consequences. Apples too are a storehouse of natural fructose. Too much consumption of apples can worsen the gout condition even more.

Is Potato good for uric acid? ›

Pros of Potatoes for Uric Acid:

Provide Fiber: Potatoes are a good source of fiber and vitamins, but they don't have much purine. This means that they're unlikely to trigger gout or raise uric acid levels. Promote Waste Excretion: In fact, potatoes may even help to lower uric acid levels by promoting urinary excretion.

Which food is avoid in uric acid? ›

The top 10 foods and drinks that trigger gout are:
  • Sugary drinks and sweets. ...
  • High fructose corn syrup. ...
  • Alcohol. ...
  • Organ meats. ...
  • Game meats. ...
  • Certain seafood, including herring, scallops, mussels, codfish, tuna, trout and haddock.
  • Red meats, including beef, lamb pork and bacon.
  • Turkey.
14 Mar 2022

Is coffee good for uric acid? ›

Coffee is thought to reduce gout risk by lowering uric acid levels through several mechanisms . Coffee may lower uric acid levels by increasing the rate that your body excretes uric acid. Coffee is also thought to compete with the enzyme that breaks down purines in the body.

Is coffee good for gout? ›

Coffee and Gout Prevention

A 2007 study investigated the potential link between coffee intake and gout risk among nearly 46,000 men. The authors found that men who drank four to five cups of coffee a day had a 40 percent lower relative risk of gout compared to men who weren't coffee drinkers.

What herb treats gout? ›

Stinging nettle (Urtica dioica) is an herbal remedy for gout that may reduce inflammation and pain. Traditional use is frequently referred to in studies.

Is vitamin B12 good for gout? ›

Use cautiously in patients with a history of gout, or elevated uric acid levels, as the correction of megaloblastic anemia with vitamin B12 may precipitate gout in susceptible individuals.

Which probiotic is good for gout? ›

Test-tube , animal, and human research suggests that the following strains of probiotics may support symptom management in people with gout: Lactobacillus (lactic acid bacteria): degrades purines in the blood and may guard against kidney damage. Bifidobacterium: counters the growth of harmful bacteria in the gut.

What drinks to avoid when you have gout? ›

Drinking sugary beverages, such as sodas sweetened with high fructose corn syrup, fruit juices or other sugar-containing drinks, is associated with gout. Notable exception: cherries, especially tart cherries, may be beneficial for gout.

Does hyperuricemia need treatment? ›

Treatment of asymptomatic hyperuricemia is not necessary in most patients, unless perhaps they have very high levels of uric acid or are otherwise at risk of complications, such as those with a personal or strong family history of gout, urolithiasis, or uric acid nephropathy.

What level of uric acid needs treatment? ›

It's recommended that treatment be started with a low dose of 100 mg which is gradually increased until uric acid levels are below 387 micromoles per liter (µmol/L), or 6.5 milligrams per deciliter (mg/dL).

Can hyperuricemia be cured naturally? ›

Nonpharmacological therapy including dietary poor in purine-rich food, sugars, alcohol, and rich in vegetables and water intake is necessary for hyperuricemia. However, it is not enough for patients with higher uric acid level. Pharmacological therapy is necessarily required.

What vegetables are high in uric acid? ›

Vegetables that have high purine content include cauliflower, spinach, and mushrooms.

Which food will reduce uric acid? ›

You'll want to go for low-purine options like:
  • Low-fat and nondairy fat products, such as yogurt and skim milk.
  • Fresh fruits and vegetables.
  • Nuts, peanut butter, and grains.
  • Fat and oil.
  • Potatoes, rice, bread, and pasta.
  • Eggs (in moderation)
18 Mar 2022

Which is best tablet for uric acid? ›

Allopurinol is a medicine used to lower levels of uric acid in your blood. If you produce too much uric acid or your kidneys do not filter enough out, it can build up and cause tiny, sharp crystals to form in and around your joints. Allopurinol is used to treat gout and kidney stones.

What is another name for hyperuricemia? ›

Definition. A high uric acid level, or hyperuricemia, is an excess of uric acid in your blood.

What are the signs and symptoms of hyperuricemia? ›

The two most common complaints associated with hyperuricemia are gout and uric acid nephrolithiasis. With gout, a patient will complain of red hot swollen joint, most commonly in the big toe. With nephrolithiasis, patients will complain of flank pain, hematuria, nausea/vomiting, and colicky pain.

What are complications of hyperuricemia? ›

Despite the modest antioxidant activity exerted by uric acid [8], hyperuricemia is a potentially harmful condition. It favors precipitation of uric acid crystals in joints and tissues, leading to complications such as gout, nephrolithiasis and chronic nephropathy.

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