Drug-induced hyperuricaemia and gout

Salem, Chaker Ben; Slim, Raoudha; Fathallah, Neila; Hmouda, Houssem

doi:10.1093/rheumatology/kew293

Cited by 122 publications

(130 citation statements)

References 82 publications

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“…The drug types significantly and most strongly associated (OR >5.0) with non-excessive polypharmacy were analgesics (OR 6.62), diuretics (OR 5.78), antidiabetics (OR 5.70), antiosteoporotics (OR 5.48) and gastric acid suppressants (OR 5.36; all P < 0.001). Similarly, the drug types significantly and most strongly associated (OR >15.0) with excessive polypharmacy (≥10 drugs) were analgesics (OR 25…”

Section: Drug Prescriptions Patternsmentioning

confidence: 99%

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Ishizaki

Mitsutake

Hamada

et al. 2020

Geriatrics Gerontology Int

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Aim To determine the patterns of concomitant drug use for chronic diseases and examine the risk factors of polypharmacy in older outpatients. Methods Data were extracted from an anonymized health insurance claims database of a public insurance program for older adults in Tokyo, Japan. We analyzed individuals aged ≥75 years who had visited an outpatient clinic, and were regularly prescribed orally administered drugs for chronic diseases for ≥14 days between May and August 2014. The prescription patterns for 16 main drug types were studied using exploratory factor analysis, and the risk factors of polypharmacy, defined as the concomitant prescription of five or more drugs, were identified using multivariate logistic regression models. Results A total of 1 094 199 outpatients were analyzed (mean age 81.8 years, 38.4% men). We identified five prescription patterns that explained almost 40% of all observed variance: edema/heart failure/atrial fibrillation‐related drugs, insomnia/anxiety‐related drugs, pain‐related drugs, lifestyle disease‐related drugs and dementia‐related drugs. The significant risk factors of polypharmacy included men, octogenarians and nonagenarians, higher number of medical institutions visited, use of physician home visits, and hospitalization during the study period. The main drug types most strongly associated with polypharmacy were analgesics, diuretics and antidiabetics. Conclusions Polypharmacy was found to be prevalent in older outpatients aged ≥75 years in Tokyo. These findings might provide useful evidence that can contribute to the development of practical countermeasures against adverse events associated with polypharmacy in clinical practice. Geriatr Gerontol Int 2020; 20: 304–311.

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Section: Drug Prescriptions Patternsmentioning

confidence: 99%

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Ishizaki

Mitsutake

Hamada

et al. 2020

Geriatrics Gerontology Int

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“…Drug‐induced hyperuricemia is a well‐known adverse effect of several anti‐TB drugs . The incidence of PZA‐induced hyperuricemia has been reported to affect 43.0%–86.3% of patients treated with PZA alone or in combination therapy .…”

Section: Discussionmentioning

confidence: 99%

“…Hyperuricemia is the biochemical precursor to gout and results from urate underexcretion, over‐production, or a combination of the 2 conditions . Hyperuricemia can occur due to diverse causes; in particular, the use of various drugs can lead to hyperuricemia and a subsequent gout attack via different mechanisms . Among them, some anti‐tuberculosis (TB) medications such as pyrazinamide (PZA) and ethambutol (EMB) are known to induce hyperuricemia and trigger gout attacks by reducing uric acid excretion in the proximal renal tubules .…”

Section: Introductionmentioning

confidence: 99%

Clinical features and risk factors for gout attacks during anti‐tuberculosis treatment: A case‐control study in South Korea

Chung

Lee

et al. 2019

Int J of Rheum Dis

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Aim This study aimed to investigate the clinical features and risk factors of gout attacks during anti‐tuberculosis (TB) treatment in South Korea. Method We investigated the clinical characteristics of 49 patients who suffered from gout attacks while taking anti‐TB medications. Among them, 25 TB patients having newly developed gout attacks without prior history of gout were set to the gout group. Seventy‐five age‐ and sex‐matched TB patients without gout attacks during anti‐TB therapy were randomly selected as the control group. The demographics, clinical features, and laboratory findings between the two groups were compared to establish risk factors of gout attack during anti‐TB treatment. Results The gout patients had a mean age of 67.7 ± 13.2 years and 39 patients (79.6%) were male. Approximately half of the patients experienced an attack within 2 months of treatment initiation. The attacks typically involved lower extremity joints (87.8%). The serum uric acid (SUA) levels were significantly elevated at 2 and 6 months after starting anti‐TB medication compared with those at baseline. In the case‐control study, the factors associated with gout attack were higher body mass index (BMI), higher pre‐treatment SUA levels, dyslipidemia, and reduced renal function. In the multivariate model, higher BMI, chronic kidney disease (CKD), and pre‐treatment hyperuricemia (SUA ≥ 6.8 mg/dL) were independent risk factors of gout attack while taking anti‐TB medication. Conclusions Patients with high BMI, CKD, and pre‐treatment hyperuricemia are at a higher risk of gout attack during TB treatment.

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“…On the flip side, several drugs are known to increase serum levels of uric acid, such as diuretics, aspirin, cyclosporine, and theophylline . Moreover, mycophenolate and ACE inhibitors are reported to induce gout in patients (incidence of 3-10% and < 1% respectively) [37, 44]. …”

Section: Urate-lowering Therapy (Ult)mentioning

confidence: 99%

Urate-Lowering Agents in Asymptomatic Hyperuricemia: Role of Urine Sediment Analysis and Musculoskeletal Ultrasound

Viggiano

Gigliotti²,

Vallone

et al. 2018

Kidney Blood Press Res

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Current urate-lowering therapy (ULT) includes three direct acting drugs (allopurinol, febuxostat, Rasburicase) and at least four ‘indirect’ drugs with other important targets (canagliflozin, losartan, fenofibrate and sevelamer). Moreover, the alcalinization of urines using bicarbonate can be used to dissolve urate crystals and the clinician may discontinue several drugs are known to increase serum levels of uric acid, such as diuretics, aspirin, cyclosporine, theophylline, mycophenolate and ACE inhibitors. While there is a consensus to start ULT in cases of symptomatic hyperuricemia (gout, urate-nephrolithiasis), the very frequent conditions of asymptomatic hyperuricemia remains a major conundrum. The effect of asymptomatic hyperuricemia on kidney function has had fluctuating positions over decades. The conflicting results might indicate: (i) the presence of counterbalancing positive and negative effects on kidney function of both serum uric acid and urate-lowering agents, (ii) the presence of a subpopulation of patients, as yet unidentified, which could truly benefit from a urate-lowering therapy. Therefore, today the treatment of asymptomatic hyperuricemia is not recommended nor excluded by current guidelines. Here we suggest that a possible guide for the treatment of asymptomatic hyperuricemia might be the presence of urate crystals in the urine sediment and/or signs of asymptomatic articular damage by urates, identified by musculo-skeletal ultrasound. Moreover, a watchful analysis of the trend in creatinine/eGFR, proteinuria or urate levels might also guide the clinician. Initiation of ULT and follow-up in cases of asymptomatic hyperuricemia should consider urine sediment analysis, musculoskeletal ultrasound and trends in creatinine, proteinuria and serum urate levels.

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Drug-induced hyperuricaemia and gout

Cited by 122 publications

References 82 publications

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Clinical features and risk factors for gout attacks during anti‐tuberculosis treatment: A case‐control study in South Korea

Urate-Lowering Agents in Asymptomatic Hyperuricemia: Role of Urine Sediment Analysis and Musculoskeletal Ultrasound

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