How should we manage asymptomatic hyperuricemia? - 16/01/19
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Highlights |
• | Hyperuricemia may be the cause or the consequence of comorbidities. |
• | Discrepancies exist between the results of observational studies (which suggest a link between hyperuricemia and comorbidities) and those of clinical trials (in which urate-lowering therapy failed to improve comorbidities). |
• | Urate-lowering therapy initiation is not recommended in patients with asymptomatic hyperuricemia, even those with monosodium urate deposits (EULAR, BSR, ACR). |
• | Optimal management of all comorbidities is of the utmost importance. |
• | Therapeutic lifestyle changes, weight loss, and regular physical activity are useful means of improving general health. |
Abstract |
The definition of asymptomatic hyperuricemia remains unclear, as no consensus exists about the serum urate cutoff or the relevance of ultrasound findings. Comorbidities associated with hyperuricemia have increased in frequency over the past two decades. Hyperuricemia (and/or gout) may be a cause or a consequence of a comorbidity. Whereas epidemiological studies suggest that hyperuricemia may be linked to cardiovascular, metabolic, and renal comorbidities, Mendelian randomization studies have not provided proof that these links are causal. Discrepancies between findings from observational studies and clinical trials preclude the development of recommendations about the potential benefits of urate-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The risk/benefit ratio of ULT is unclear. The risk of developing gout, estimated at 50%, must be weighed against the risk of cutaneous and cardiovascular side effects of xanthine oxidase inhibitors. The need for optimal comorbidity management, in contrast, is universally accepted. Medications for comorbidities that elevate urate levels should be discontinued and replaced with medications that have the opposite effect. Therapeutic lifestyle changes, weight loss as appropriate, and sufficient physical activity are useful for improving general health. Whether ULT has beneficial effects on comorbidities will be known only when well-powered interventional trials with relevant primary endpoints are available.
Le texte complet de cet article est disponible en PDF.Keywords : Asymptomatic hyperuricemia, Ultrasonography, Comorbidities, Hypertension, Coronary artery disease, Metabolic syndrome, Chronic kidney disease, Urate-lowering therapy, Lifestyle measures
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