Introduction to asymptomatic hyperuricaemia
Hyperuricaemia (high serum uric acid concentration) is a laboratory finding that can be found in some routine tests ordered by clinicians. Serum uric acid tests should only be used for the diagnosis and monitoring of gout or pregnancy-induced hypertension, and for the monitoring of therapy in malignancies where there is a high rate of cell destruction and uric acid productionThe Royal College of Pathologists of Australasia (RCPA), 2019. Isolated asymptomatic hyperuricaemia does not require pharmacological management, see Management of asymptomatic hyperuricaemia for discussion.
While most people with hyperuricaemia do not have gout, the risk of gout increases with increasing serum uric acid concentration. While approximately only 1% of people with a serum uric acid concentration below 0.36 mmol/L (6 mg/dL) will develop gout over the next 15 years, gout develops in almost 50% of people with a serum uric acid concentration greater than 0.55 mmol/L (10 mg/dL)Dalbeth, 2018. Up to 25% of people with asymptomatic hyperuricaemia may have asymptomatic monosodium urate crystal depositionDalbeth, 2015Andres, 2016; presence of crystals does not alter management. For a discussion of risk factors for hyperuricaemia and gout, see Pathogenesis of and risk factors for gout.
The prevalence of hyperuricaemia, like gout, steadily increased in the 20th century but appears to have plateaued in developed countriesChen-Xu, 2019. The incidence of hyperuricaemia is estimated to be slightly greater in males than females. The prevalence of hyperuricaemia is much higher in Māori and Pacific Islander peoples and is likely to also be higher in Aboriginal and Torres Strait Islander peoples, but there are no data to confirm this. The prevalence of hyperuricaemia increases with age.
Growing evidence supports a pathogenic role for hyperuricaemia in the development of hypertension, type 2 diabetes, and atherosclerotic cardiovascular disease and its consequences (eg stroke, myocardial infarction and cardiovascular death). Hyperuricaemia may also contribute to kidney disease.