Urate-lowering therapy for asymptomatic hyperuricaemia: A need for caution

Semin Arthritis Rheum. 2017 Feb;46(4):457-464. doi: 10.1016/j.semarthrit.2016.07.015. Epub 2016 Jul 28.


Objective: The observed associations of hyperuricaemia with hypertension, cardiovascular disease and kidney disease are receiving increasing interest. The potential role of urate-lowering therapy in the management of these "non-gout diseases" has been raised, and in some countries it is already recommended. However, there is no consistent definition of hyperuricaemia or asymptomatic hyperuricaemia, much remains unknown about the causal role of urate in these "non-gout diseases" and there is currently a lack of evidence about the effects of urate lowering on disease progression. In addition, there is potential for serious adverse effects associated with urate-lowering therapies with recent evidence suggesting that asymptomatic hyperuricaemia may be an independent risk factor for the potentially fatal allopurinol hypersensitivity syndrome.

Methods: Pubmed was searched in January 2016 using the search term "asymptomatic hyperuricaemia".

Results and conclusions: Herein, we discuss the issues related to treating asymptomatic hyperuricaemia, which at present seems premature.

Keywords: Asymptomatic; Hyperuricaemia; Urate-lowering therapy.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allopurinol / therapeutic use
  • Asymptomatic Diseases*
  • Drug Eruptions / etiology
  • Drug Hypersensitivity / etiology
  • Febuxostat / therapeutic use
  • Gout Suppressants / therapeutic use
  • Humans
  • Hyperuricemia / drug therapy*
  • Probenecid / therapeutic use
  • Uricosuric Agents / therapeutic use*
  • Urolithiasis / chemically induced


  • Gout Suppressants
  • Uricosuric Agents
  • Febuxostat
  • Allopurinol
  • Probenecid