Management of Patients with Asymptomatic Hyperuriсemia – to Treat or not to Treat?
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Abstract
The article discusses the causes of hyperuricemia, including the influence of factors such as obesity, metabolic syndrome, decreased renal function.
Hyperuricemia is called an increase in serum uric acid more 360 μmol/l in women and more than 420 μmol/l in men. The most reasonable level of uric acid is considered to be no more than 6.8 mg/dl (400 μ mol/L), at which crystallization occurs under physiological conditions. The prevalence of comorbidities associated with hyperuricemia has increased over the past two decades.
Hyperuricemia (and/or gout) can be a cause or consequence of a comorbid condition. While epidemiological studies suggest that hyperuricemia may be associated with cardiovascular, metabolic, and renal concomitant diseases, Mendelian randomization studies have not provided evidence that these relationships are causative. The discrepancies between the results of observational and clinical studies do not allow making recommendations about the potential benefits of urat-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The relationship between risk and benefit o f ULT is unclear.
The risk of gout developing as a result of asymptomatic hyperuricemia, estimated at 50%, must be matched with the risk of skin and cardiovascular side effects of xanthine oxidase inhibitors. On the contrary, the need for optimal management of comorbidities is widely recognized. Among the drugs taken by patients to treat comorbidities, those therapeutic agents with hyperuricemic action should be canceled and replaced with drugs that have the opposite effect. Lifestyle changes, weight loss, if necessary, and sufficient physical activity are useful for improving overall health. Whether ULT has a beneficial effect on comorbidities will only be known if there are powerful intervention tests with appropriate primary endpoints.##plugins.themes.bootstrap3.article.details##
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References
Головач И.Ю. Расширение границ уратснижающей терапии: место фебуксостата в лечении подагры / И.Ю. Головач, Е.Д. Егудина // Травма. – 2019. – T. 2, № 20. – С. 20–30.
Головач И.Ю. Мочевая кислота и деменция: патогенный фактор или маркер когнитивного здоровья? / И.Ю. Головач, Е.Д. Егудина // Журнал неврології ім. Б.М. Маньковського. – 2019. – Т. 7, № 2. – С. 34–44.
Головач І.Ю. Подагра: стара знайома в рамках сучасних рекомендацій / І.Ю. Головач, Є.Д. Єгудіна // Практикуючий лікар. – 2019. – Т. 8, № 2. – С. 9–27.
Monosodium urate crystal deposits are common in asymptomatic sons of people with gout – the sons of gout study. / A. Abhishek, P. Courtney, W. Jenkins, et al. // Arthritis Rheumatol. – 2018. – Vol. 70. – P. 1847–52.
Abhishek A. Education and non-pharmacological approaches for gout / A. Abhishek, M. Doherty // Rheumatology. – 2018. – Vol. 57. – P. 51–8.
Treatment of asymptomatic hyperuricemia: a decision analytic approach. / R. Akkineni, S. Tapp, A.N. Tosteson, et al. // J Rheumatol. – 2014. – Vol. 41. – P. 739–48.
Silent monosodium urate deposits are associated with severe coronary calcification in asymptomatic hyperuricemia: an exploratory study / M. Andrés, M.A. Quintanilla, F. Sivera, et al. // Arthritis Rheumatol. – 2016. – Vol. 68. – P. 1531–9.
Bardin T. Definition of hyperuricemia and gouty conditions / T. Bardin, P. Richette // Curr Opin Rheumatol. – 2014. – Vol. 26. – P. 186–91.
Bardin T. Hyperuricemia starts at 360 micromoles (6 mg/dL) / T. Bardin // Joint Bone Spine. – 2015. – Vol. 82. – P. 141–3.
Risk of cutout adverse reactions with febuxostat treatment. A retro-spective, hospital-based study of 101 patients with consecutive allopurinol and febuxostat treatment / T. Bardin, G. Chalès, T. Pascart, et al. // Joint Bone Spine. – 2016. – Vol. 83. – P. 314–7.
Bardin T. Impact of comorbidities on the gout and hyperuricaemia: an update on prevalence and treatment options / T. Bardin, P. Richette // BMC Med. – 2017. – Vol. 15. – P. 123.
Becker MA. Clinical aspects of monosodium urate monohydrate crystal deposition disease (gout) / M.A. Becker // Rheum Dis Clin North Am. – 1988. – Vol. 14. – P. 377.
Bellomo G, Selvi A. Uric acid: the lower the better? / G. Bellomo, A. Selvi // Contrib Nephrol. – 2018. – Vol. 192. – P. 69–76.
Beyl Jr R.N. Update on importance of diet in gout / R.N. Beyl Jr, L. Hughes, S. Morgan // Am J Med. – 2016. – Vol. 129. – P. 1153–8.
Uric acid metabolic syndrome, impaired fasting, glucose and diabetes mellitus associate-zioni study / M. Bombelli, F. Quarti-Trevano, M. Tadic, et al. // J Hypertens. – 2018. – Vol. 36. – P. 1492–8.
Serum uric acid and the risk of cardiovascular and renal disease / C. Borghi, E.A. Rosei, T. Bardin, et al. // J Hypertens. – 2015. – Vol. 33. – P. 1729–41.
Xanthine oxidase inhibitors for cardiovascular events: a systematic review and randomized controlled trials / M. Bredemeier, L.M. Lopes, M.A. Eisenreich, et al. // BMC Cardiovasc Disord. – 2018. – Vol. 18. – P. 24.
Campion E.W. Asymptomatic hyperuricemia. Risks and consequences in the normative aging study / E.W. Campion, R.J. Glynn, L.O. DeLabry. // Am J Med. – 1987. – Vol. 82. – P. 421–6.
Severe cut chemical adverse reactions due to inappropriate medication use / G. Chaby, L. Valeyrie-Allanore, T.A. Duong, et al. // Br J Dermatol. – 2018. – Vol. 179. – P. 329–36.
Chalès G. How should we manage asymptomatic hyperuricemia? / G. Chalès // Joint Bone Spine. – 2019. – Vol. 86, N 4. – P. 437–443.
Mediterranean diet intervention for patients with hyperuricemia: a pilot study / M. Chatzipavlou, G. Magiorkinis, L. Koutsogeorgopoulou, D. Kassimos // Rheumatol Int. – 2014. – Vol. 34. – P. 759–62.
Attenuating the mortality risk of high serum uric acid: the role of physical activity underused / J.H. Chen, C.P. Wen, S.B. Wu, et al. // Ann Rheum Dis. – 2015. – Vol. 74. – P. 2034–42.
U-Shaped association between serum: a cohort study / S.K. Cho, Y. Chang, I. Kim, S. Ryu // Arthritis Rheumatol. – 2018. – Vol. 70. – P. 1122–32.
Choi H.K. A prescription for lifestyle changes in patients with hyperuricemia and gout / H.K. Choi // Curr Opin Rheumatol. – 2010. – Vol. 22. – P. 165–72.
Patients with hypertension: population-based case-control study / H.K. Choi, L.C. Soriano, Y. Zhang, et al. // BMJ. – 2012. – Vol. 344. – P. 8190.
Curhan G.C. 24-h uric acid excretion and the risk of kidney stones / G.C. Curhan, E.N. Taylor. // Kidney Int. – 2008. – Vol. 73. – P. 489.
Dalbeth N. Hyperuricaemia and gout: time for a new staging system? / N. Dalbeth, L. Stamp // Ann Rheum Dis. – 2014. – Vol. 73. – P. 1598–600.
Relationship between serum urate concentration and clinically evident incident gout: an individual participant data analysis / N. Dalbeth, A. Phipps-Green, C. Frampton, et al. // Ann Rheum Dis. – 2018. – Vol. 77. – P. 1048–52.
An evaluation of longitudinal changes in serum uric acid levels and associated risk of cardio-metabolic events and renal function decline in gout / R.J. Desai, J.M. Franklin, J. Spoendlin-Allen, et al. // PLOS One. – 2018. – Vol. 13. – P. 0193622.
Asymptomatic hyperuricemia and chronic kidney disease: narrative review of a treatment controversial / T. Eleftheriadis, S. Golphinopoulos, G. Pissas, et al. // J Adv Res. – 2017. – Vol. 8. – P. 555–60.
It is a population-based study for 20 years / M.M. Elshawi, N. Zleik, Z. Kvrgic, et al. // J Rheumatol. – 2018. – Vol. 45. – P. 574–9.
Levels of cytokines and microRNAs in individuals with asymptomatic hyperuricemia and an ultra-sonographic setting of gout: a bench-to-bedside approach / I.O. Estevez-Garcia, S. Gallegos-Nava, E. Vera-Pérez, et al. // Arthritis Care Res. – 2018. – Vol. 70, N 12. – P. 1814–1821.
Serum urate association with hypertension in young adults: analysis from cohort / A.L. Gaffo, D.R. Jacobs Jr, F. Sijtsma, et al. // Ann Rheum Dis. – 2013. – Vol. 72. – P. 1321–7.
Effects of xanthine oxidation inhibition in hyperuricemic heart failure patients inhybition for hyperuricemic heart failure patients (EXACT-HF) STUDY / M.M. Givertz, K.J. Anstrom, M.M. Redfield, et al. // Circulation. – 2015. – Vol. 131. – P. 1763–71.
Mediterranean diet and risk of hyperuricemia in elderly participants at high cardiovascular risk / M. Guasch-Ferré, M. Bulló, N. Babio, et al. // J Gerontol A Biol Sci Med Sci. – 2013. – Vol. 68. – P. 1263–70.
Gul A. Does altered acid metabolism contribute to diabetic kidney disease pathophysiology? / A. Gul, P. Zager // Curr Diab Rep. – 2018. – Vol. 18. – P. 18.
Hak A.E. Menopause, postmenopausal hormone uses and serum uric acid levels in US women – the Third National Health and Nutrition Examination Survey / A.E. Hak, H.K. Choi // Arthritis Res Ther. – 2008. – Vol. 10. – P. 116.
Holland R. Comprehensive dietary education in treated patients doesn’t further improve serum urate / R. Holland, N.W. McGill // Intern Med J. – 2015. – Vol. 45. – P. 189–94.
Hyperuricemia, chronic kidney disease, hypertension, and cardiovascular disease: report organized by the National Kidney Foundation / R.J. Johnson, G.L. Bakris, C. Borghi, et al. // Am J Kidney Dis. – 2018. – Vol. 71. – P. 851–65.
Effects of the Dietary Approaches To Stop Hypertension (DASH) Diet and Sodium Intake on Serum Uric Acid / S.P. Juraschek, A.C. Gelber, H.K. Choi, et al. // Arthritis Rheum. – 2016. – Vol. 68. – P. 3002–9.
Jutabha P. Human sodium phosphate transporter 4 (hNPT4/SLC17A3) as a common renal secretory pathway for drugs and urate / P. Jutabha, N. Anzai, K. Kitamura, et al. // J Biol Chem. – 2010. – Vol. 285. – P. 35123.
Synergistic association of changes in serum uric acid and triglycerides with changes in insulin resistance after walking exercise in community-dwelling older women / R. Kawamoto, T. Katoh, D. Ninomiya, et al. // Endocr Res. – 2016. – Vol. 41. – P. 116–23.
Ultrasonographic assessment of joint pathology in diabetes and hyperuricemia: the Fremantle diabetes study phase II / H.I. Keen, W.A. Davis, E. Latkovic, et al. // J Diabetes Complications. – 2018. – Vol. 32. – P. 400–5.
Causal cardiometabolic diseases through a mendelian randomization study / T. Keenan, W. Zhao, A. Rasheed, et al. // J Am Coll Cardiol. – 2016. – Vol. 67. – P. 407–16.
Uric acid and cardiovascular risk: What genes can say / A. Kei, F. Koutsouka, A Makri, et al. // Int J Clin Practices. – 2018. – Vol. 72. – P. 13048.
Time to target uric acid to retard CKD progression / T. Kumagai, T. Ota, Y. Tamura, et al. // Clin Exp Nephrol. – 2017. – Vol. 21. – P. 182–92.
Elevated serum uric acid level predicts rapid decline in kidney function / M. Kuwabara, P. Bjornstad, I. Hisatome, et al. // Am J Nephrol. – 2017. – Vol. 45. – P. 330–7.
Uric acid is a strong risk marker for developing hypertension from prehypertension: a 5-year Japanese cohort study / M. Kuwabara, I. Hisatome, K. Niwa, et al. // Hypertension. – 2018. – Vol. 71. – P. 78–86.
Is there a chronic kidney disease? A systematic review and meta-analysis based on observational cohort studies / L. Li, C. Yang, Y. Zhao, et al. // BMC Nephrol. – 2014. – Vol. 15. – P. 122.
It can be noted that it will be possible to complete the course of the study / X. Li, X. Meng, M. Timofeeva, et al. // BMJ. – 2017. – Vol. 357. – P. 2376.
Effects of uric acid-kidney disease: a systematic review and meta-analysis / X. Liu, T. Zhai, R. Ma, et al. // Ren Fail. – 2018. – Vol. 40. – P. 289–97.
Lioté F. From hyperuricaemia to gout: what are the missing links? / F. Lioté, T. Pascart // Nat Rev Rheumatol. – 2018. – Vol. 14. – P. 448–9.
Hyperuricemia as a prognostic factor of late coronary syndrome / A. Lopez-Pineda, A. Cordero, C. Carratala-Munuera, et al. // Atherosclerosis. – 2018. – Vol. 269. – P. 229–35.
Clinical characteristics of and relationship between metabolic components and renal function among patients with early onset juvenile tophaceous gout / C.C. Lu, S.K. Wu, H.Y. Chen, et al. // J Rheumatol. – 2014. – Vol. 41. – P. 1878.
Gout and the risk of Alzheimer’s disease: a population-based, BMI-matched cohort study / N. Lu, M. Dubreuil, Y. Zhang, et al. // Ann Rheum Dis. – 2016. – Vol. 75. – P. 547.
High-level diabetes: a systemic review and meta-analysis of prospective cohort studies / Q. Lv, X.F. Meng, F.F. He, et al. // PLOS ONE. – 2013. – Vol. 8. – P. 56864.
Gout epidemiology: results from the UK General Practice Research Database, 1990–1999 / T.R. Mikuls, J.T. Farrar, W.B. Bilker, et al. // Ann Rheum Dis. – 2005. – Vol. 64. – P. 267.
Serum uric acid in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study / S.L. Mumford, S.S. Dasharathy, A.Z. Pollack, et al. // Hum Reprod. – 2013. – Vol. 28. – P. 1853.
Activation of the bumetanide-sensitive Na+, K+, 2Cl – cotransporter (NKCC2) is facilitated by Tamm-Horsfall protein in a chloride-sensitive manner / K. Mutig, T. Kahl, T. Saritas, et al. // J Biol Chem. – 2011. – Vol. 286. – P. 30200.
Management of asymptomatic hyperuricaemia in patients with chronic nephrologists in Japanese patients: a questionnaire survey / I. Nakaya, T. Namikoshi, Y. Tsuruta, et al. // Nephrology. – 2011. – Vol. 16. – P. 518–21.
Neogi T. Asymptomatic hyperuricemia: cardiovascular and renal implications / T. Neogi // In: Terkeltaub R, editor. Gout & other crystal arthropathies. Philadelphia: W.B. Saunders. – 2012. – P. 226–38.
Okafor O.N. Allopurinol as a option in cardiovascular disease / O.N. Okafor, K. Farrington, D.A. Gorog // Pharmacol Ther. – 2017. – Vol. 172. – P. 139–50.
Pascart T. Gout: state of the art after decade of developments / T. Pascart, F. Lioté // Rheumatology. – 2019. – Vol. 58, N 1. – P. 27–44.
Paul B.J. Asymptomatic hyperuricemia: is it time to intervene? / B.J. Paul, K. Anoopkumar, V. Krishnan // Clin Rheumatol. – 2017. – Vol. 36. – P. 2637–44.
Perez-Ruiz F. Hyperuricaemia with deposition: latest evidence and therapeutic approach / F. Perez-Ruiz, E. Marimon, S.P. Chinchilla // Ther Adv Musculoskelet Dis. – 2015. – Vol. 7. – P. 225–33.
The relationship between apolipoprotein B and very low-density lipoprotein triglyceride with hyperuricemia and gout / H. Rasheed, A. Hsu, N. Dalbeth, et al. // Arthritis Res Ther. – 2014. – Vol. 16. – P. 495.
Reuss-Borst M.A. Hidden gout ultrasound findings in patients with musculoskeletal problems and hyperuricemia / M.A. Reuss-Borst, C.A. Pape, A.K. Tausche // Springerplus. – 2014. – Vol. 3. – P. 592.
updated EULAR evidencebased recommendations for the management of gout / P. Richette, M. Doherty, E. Pascual, et al. // Ann Rheum Dis. – 2017. – Vol. 76. – P. 29–42.
Richette P. Cardiac and lower resistance therapy / P. Richette, A. Latourte, T. Bardin // Rheumatology. – 2018. – Vol. 57. – P. 47–50.
Roddy E. Epidemiology of gout / E. Roddy, H.K. Choi // Rheum Dis Clin North Am. – 2014. – Vol. 40. – P. 155.
Sánchez-Lozada LG. The pathophysiology of uric acid on renal diseases / L.G. Sánchez-Lozada // Contrib Nephrol. – 2018. – Vol. 192. – P. 17–24.
Serum uric acid and chronic kidney disease: the role of hypertension / S. Sedaghat, E.J. Hoorn, F.J. van Rooij, et al // PLOS One. – 2013. – Vol. 8. – P. 76827.
Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: a review / E.I. Sharaf, U.A. Din, M.M. Salem, D.O. Abdulazim // J Adv Res. – 2017. – Vol. 8. – P. 537–48.
Serum uric acid and the risk of incident and recurrent gout: A systematic review / A. Shiozawa, S.M. Szabo, A. Bolzani A, et al. // J Rheumatol. – 2017. – Vol. 44. – P. 388–96.
Stamp L. Screening for hyperuricaemia and gout: a perspective and research agenda / L. Stamp, N. Dalbeth // Nat Rev Rheumatol. – 2014. – Vol. 10. – P. 752–6.
Stamp L. Urate-lowering therapy: A need for caution / L. Stamp, N. Dalbeth // Semin Arthritis Rheum. – 2017. – Vol. 46. – P. 457–64.
Stamp L.K. How to prevent allopurinol hypersensitivity reactions? / L.K. Stamp, M.L. Barclay // Rheumatology. – 2018. – Vol. 57. – P. 35–41.
Ultrasound features of the metatar-sophalangeal joint in gout and asymptomatic hyperuricemia: comparison with normouricemic individuals / S. Stewart, N. Dalbeth, A.C. Vandal, et al. // Arthritis Care Res. – 2017. – Vol. 69. – P. 875–83.
Uric acid-lowering therapy in patients with chronic kidney disease: a meta-analysis / X. Su, B. Xu, B. Yan, et al. // PLOS One. – 2017. – Vol. 12. – P. 0187550.
Untangling the complex relationships between incident risk, serum urate, and its comorbidities / M. Sun, A.I. Vazquez, R.J. Reynolds, et al. // Arthritis Res Ther. – 2018. – Vol. 20. – P. 90.
Uric acid over time / O. Tang, E.R. Miller, A.C. Gelber, et al. // Clin Rheumatol. – 2017. – Vol. 36. – P. 1413–7.
Hepatocyte Nuclear Factor 1β-Associated Kidney Disease: More than Renal Cysts and Diabetes / J.C. Verhave, A.P. Bech, J.F. Wetzels, T. Nijenhuis // J Am Soc Nephrol. – 2016. – Vol. 27. – P. 345.
Effect of fenofibrat on uric acid and gout in type 2 diabetes: a post-hocanalyte of the randomized, controlled FIELD study / B. Waldman, J.C. Ansquer, D.R. Sullivan, et al. FIELD investigators // Lancet Diabetes Endocrinol. – 2018. – Vol. 6. – P. 310–8.
Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT / P. Wang, S.E. Smith, R. Garg, et al. // RMD Open. – 2018. – Vol. 4. – P. 000593.
CARES Investigators. Cardiovascular safety in febuxostat or allopurinol in patients with gout / W.B. White, K.G. Saag, M.A. Becker, et al. // N Engl J Med. – 2018. – Vol. 378. – P. 1200–10.
Asymptomatic hyperuricemia and coronary artery disease in the elderly patients without comorbidities / J. Wu, G. Lei, X. Wang, et al. // Oncotarget. – 2017. – Vol. 8. – P. 80688–99.
Serum uric acid and mortality in chronic kidney disease: A systematic review and meta-analysis / X. Xia, Q. Luo, B. Li, et al. // Metabolism. – 2016. – Vol. 65. – P. 1326–41.
Hyperuricemia increases kidney injury risk: a systematic review and meta-analysis / X. Xu, J. Hu, N. Song, et al. // BMC Nephrol. – 2017. – Vol. 18. – P. 27.
Yamanaka H. Japanese society of gout and nucleic acid metabolism. Japanese guideline for the management of hyperuricemia and gout: second edition / H. Yamanaka // Nucleosides Nucleotides Nucleic Acids. – 2011. – Vol. 30. – P. 1018–29.
Serum uric acid levels meta-analysis of prospective studies / H. Yuan, C. Yu, X. Li, et al. // J Clin Endocrinol Metab. – 2015. – Vol. 100. – P. 4198–207.
Estrogen receptor β signaling induces autophagy and downregulates Glut9 expression / M. Zeng, B. Chen, Y. Qing, et al. // Nucleosides Nucleotides Nucleic Acids. – 2014. – Vol. 33. – P. 455.
Efficacy of febuxostat in hyperuricemic patients with mild-to-moderate chronic kidney disease: a meta-analysis of randomized clinical trials: a PRISMAcompliant article / X.X. Zeng, Y. Tang, K. Hu, et al. // Medicine. – 2018. – Vol. 97. – P. 0161.
Zhu Y. Prevalence of gout and hyperuricemia in the US general population survey of 2007–2008 / Y. Zhu, B.J. Pandya, H.K. Choi // Arthritis Rheum. – 2011. – Vol. 63. – P. 3136–41.
Zhu Y. Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007–2008 / Y. Zhu, B.J. Pandya, H.K. Choi // Am J Med. – 2012. – Vol. 125. – P. 679.
Serum uric acid is associated with incidental kidney disease in the middle-aged populations: a meta-analysis of 15 cohort studies / P. Zhu, Y. Liu, L. Han, et al. // PLOS One. – 2014. – Vol. 9. – P. 100801.
Zhu Y. An update on the animal models in hyperuricaemia research / Y. Zhu, X. Peng, G. Ling // Clin Exp Rheumatol. – 2017. – Vol. 35. – P. 860–4.
Zoccali C. Uric acid in chronic kidney disease: the quest for causality continues / C. Zoccali, F. Mallamaci // Nephrol Dial Transplant. – 2018. – Vol. 33. – P. 193–5.