Source: Ernst ME, Clark EC. Gout
and Hyperuricemia. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells
BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7997829.
Accessed June 30, 2012.
- Elevated serum uric acid concentration (>7 mg/dL [416 μmol/L] in men or >6 mg/dL [357 μmol/L] in women).
- Increased activity of phosphoribosyl pyrophosphate (PRPP)
- Deficiency of hypoxanthine–guanine phosphoribosyl
- Myeloproliferative and lymphoproliferative disorders
- Cytotoxic drug therapy
- Nicotinic acid
- Salicylates (<2 g/day)
- Abnormalities in enzyme systems that regulate purine metabolism
may result in overproduction of uric acid.
activity of PRPP synthetase
- Deficiency of HGPRT
- Uric acid overproduction may occur because of increased breakdown
of tissue nucleic acids in myeloproliferative and lymphoproliferative
- Cytotoxic drug therapy also leads to overproduction of uric
- Drugs can decrease renal clearance of uric acid.
- Prevalence of asymptomatic hyperuricemia in United States
estimated to be 2–13%.
- Hyperuricemia and gouty arthritis are more common in men than
- Risk of developing hyperuricemia increases with age.
Means of Confirmation
- Obtain medical history to determine whether patient has
symptoms and to identify causes and comorbid conditions.
- Elevated serum uric acid level (>7 mg/dL [416 μmol/L] in men or >6 mg/dL [357 μmol/L] in women.
- Complete blood count (CBC)
- Serum electrolytes
- Blood urea nitrogen
- Liver function tests
- Fasting lipid profile
- Calcium and phosphorus
- Thyroid-stimulating hormone
- Consider 24-hour urine collection for creatinine and uric
acid to determine whether patient is overproducing or underexcreting
- Prevent attacks of acute gouty arthritis.
- In some cases, normalize serum uric acid concentration.
- Goal of urate-lowering therapy: achieve and maintain serum
uric acid concentration <6 mg/dL (357 μmol/L)
and preferably <5 mg/dL (297 μmol/L).
- Consider uric-acid lowering therapy in patients with history
of recurrent acute gouty arthritis and significantly elevated serum
uric acid concentration.
- Urate-lowering therapy should not begin until 6–8
weeks after resolution of acute gout episode.
- Reduction of serum urate concentration can be accomplished
by decreasing uric acid synthesis (xanthine oxidase inhibitors)
or by increasing renal excretion of uric acid (uricosurics).
- Give colchicine 0.6 mg once daily for at least first 8 weeks
of antihyperuricemic therapy to minimize risk of acute attacks.
- Reduce dietary intake of saturated fats and meats high
in purines (e.g., organ meats).
- Avoid alcohol.
- Increase fluid intake.
- Lose weight if obese.
- Xanthine oxidase inhibitors
100 mg daily initially, increased by 100 mg daily at 1-week intervals.
- Typical doses: 100–300 mg daily, but some patients
may require 600–800 mg daily.
- Reduce dose in renal insufficiency ...