Management of asymptomatic hyperuricaemia

Pharmacological treatment should not be started for isolated asymptomatic hyperuricaemia, even if comorbidities are present (eg chronic kidney or cardiovascular disease, kidney stones or hypertension) or monosodium urate crystal deposition is identified on imaging tests. The benefits of urate-lowering therapy are unlikely to outweigh the harmsRichette, 2020 FitzGerald, 2020. However, because of the relationship between hyperuricaemia and kidney and cardiovascular disease, the patient’s kidney function should be measured and their cardiovascular disease risk factors should be closely monitored and actively managed (see Atherosclerotic cardiovascular disease risk estimation). Management may include providing advice on maintaining ideal body weight, treating associated comorbidities, and addressing other lifestyle risk factors such as diet (eg reducing consumption of alcohol [particularly beer and spirits], fructose-sweetened drinks, meat, and shellfish)Dalbeth, 2015.

Note: Pharmacological treatment should not be started for isolated asymptomatic hyperuricaemia because the benefits of urate-lowering therapy are unlikely to outweigh the harms.

Treatment of asymptomatic hyperuricaemia may be indicated for some haematological disorders associated with increased cell turnover (eg myeloproliferative disease). If pharmacological management is indicated, urate-lowering therapy is used as for the management of gout (see Pharmacological management for chronic gout). Flare prophylaxis is recommended for patients with gout who start urate-lowering therapy; however, there is insufficient evidence to recommend it in patients with asymptomatic hyperuricaemia.

If asymptomatic hyperuricaemia is due to drug therapy (eg a thiazide or loop diuretic), consider switching to an alternative drug or reducing the dosage of the contributing drug if switching is not possible.