Asymptomatic Hyperuricemia: Evidence to Treat Above a Certain Threshold Value?german translation / full article
A 67 year old patient with diabetes mellitus type 2, past myocardial infarction and stenting of the LAD, hypertension and hypertriglyceridemia consults his family physician for a check up visit. Uric acid levels are determined at 11.6 mg/dl. Up to now the patient did not suffer from gouty arthritis or uric calculi, and there is no known genetic predisposition for the development of gouty arthritis. The family physician questions whether this patient should be treated with a uric acid lowering drug (e.g. allopurinol) to prevent future gouty arthritis or to improve his cardiovascular or renal risk.
There is a striking deficiency of high quality studies investigating the preventive effects of drug treatment of asymptomatic hyperuricemia. Current low-level evidence pointing at a possible beneficial effect can only be used to propose hypotheses. In the light of the rare but possibly fatal allopurinol hypersensitivity syndrome allopurinol treatment of asymptomatic hyperuricemia should be avoided. This also applies to very high uric acid serum levels.