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Hyperuricemia and Gout

When the body has a high level of uric acid, urate will then deposit within the joints and this will result in inflammation and pain. This condition is known as gout. Once this happens, the area of affliction is most often in a single joint, particularly in the big toe. The afflicted area suddenly becomes red, swollen, heated, and painful. After a few days, the pain will begin to subside. However, if the level of uric acid is not well controlled, the chance of recurrent gout attack increases. In the long term, this could result in complications such as joint erosion, urate kidney stones, chronic gouty nephropathy, and tophi.1


Hyperuricemia is defined as serum urate levels that are above 7.0mg/dL (0.42mmol/L) in men and 6.0mg/dL (0.36mmol/L) in women. 1 Esteemed international rheumatology societies suggest that patients with gout should lower their blood uric acid levels to below 6.0mg/dL (0.36mmol/L) or even to below 5.0mg/dL (0.30mmol/L), to effectively reduce the incidence of gout attacks.2-3


The treatment of gout can be divided into two phases. During an acute gout attack, a non-steroidal anti-inflammatory drug (NSAID), colchicine or a corticosteroid may be used to reduce the inflammation and pain. To effectively reduce the incidence of gout attacks, uric acid lowering drugs should be used during the intercritical stage to reduce the concentration of uric acid to a target level.4


There are two main types of uric acid lowering medications:1-4

  • Xanthine oxidase inhibitors
    Xanthine oxidase inhibitors, including febuxostat and allopurinol, can inhibit the formation of uric acid, thus lowering uric acid levels. They are the first line uric acid lowering drugs.3 Febuxostat is the first uric acid lowering drug in the past 40 years and has been shown to be more effective in reducing uric acid levels than allopurinol.4
  • Uricosurics
    By increasing urate excretion through the kidneys, uricosurics have the ability to reduce uric acid levels. Commonly used uricosurics include probenecid and benzbromarone. As second line uric acid lowering drugs, they are not recommended for patients with kidney failure or with history of kidney stones.


1.Teng GG, et al. Drugs 2006;66(12):1547-1563.
2.Jordan KM, et al. Rheumatology 2007;46:1372-1374.
3.Khanna D, et al. Arthritis Care & Research 2012;64(10):1431-1446
4.Gaffo AL, et al. Core Evidence 2009;4:25-36.



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