The inflammatory response to the precipitation of monosodium urate (MSU) crystals in both articular and non-articular tissues is a feature of a medical condition called gout. Gout is a type of arthritis that occurs when serum uric acid (SUA), uric acid levels in the blood, become elevated leading to the formation of MSU crystals in and around joints and other tissues.
This can lead to an inflammatory response and manifest in various ways with painful symptoms, swelling and discomfort ranging from mild to severe. While it’s often associated with being overweight, having a family history of gout, a rich diet and excessive alcohol consumption, there’s much more to this condition than meets the eye. Uric acid is a waste product produced by the body when it breaks down purines, which are found in certain foods and occur naturally in the body.
Gout can be effectively controlled, and the frequency and severity of gout attacks can be significantly reduced with appropriate pharmacologic management and lifestyle changes.
There are several medications and medical conditions that can potentially increase uric acid levels in the body. Elevated uric acid levels can contribute to the development of conditions like gout or kidney stones.
Here are some medications that may lead to elevated uric acid levels:
| ACE Inhibitors | Loop & Thiazide Diuretics | Pyrazinamide | Tacrolimus |
| Ethambutol | Niacin | Ritonavir | Teriparatide |
| Lactate Infusion | Non-Losartan ARBs | Salicylates (<2g day) | Testosterone |
Increased awareness of drugs that can induce hyperuricemia and gout, coupled with vigilant monitoring and preventive measures, are vital components for reducing the morbidity associated with drug-induced hyperuricemia and gout.
While medications primarily used to treat gout are the most common options for lowering uric acid levels, there are certain medications prescribed for other conditions that may have the side effect of lowering uric acid levels. These medications are not specifically intended for gout treatment but can help manage uric acid levels as a secondary effect. Here are some examples:
| Losartan | Losartan is an angiotensin II receptor blocker (ARB) commonly used to treat high blood pressure. Some studies suggest that losartan may have a uricosuric effect, meaning it can increase uric acid excretion by the kidneys, thereby lowering uric acid levels. | The American College of Rheumatology (ACR) guidelines recommend choosing losartan preferentially as antihypertensive therapy in patients with gout when feasible. |
| Fenofibrate | Fenofibrate is often prescribed to manage high triglyceride levels and improve lipid profiles. Some individuals may experience a reduction in uric acid levels while taking fenofibrate. | Although there are proven benefits in reducing urate levels, the guidelines provided by the ACR advise against supplementing or changing cholesterol-lowering medications with fenofibrate. This is because fenofibrate is not considered a preferred treatment option according to the current lipid management guidelines. |
Other agents have been associated with decreased uric acid level and the risk of gout; these include statins (atorvastatin, simvastatin), SGLT-2 inhibitors (canagliflozin, empagliflozin, dapagliflozin) and metformin.
Gout is a controllable medical condition, and through the right approach, one can mitigate its impact on their quality of life. The management of gout is an ongoing process, and it’s essential to stay informed and proactive and collaborate closely with healthcare professionals.
There are multiple ways to approach treatment to gout that depend on the patient. If you are interested in learning more about differing treatment options, check out our ‘Gout Treatment’ page that details the major do’s and don’ts to know when managing gout.
References
Ben Salem C, Slim R, Fathallah N, Hmouda H. Drug-induced Hyperuricemia and gout. Rheumatology (Oxford). 2017;56(5):679-688. doi:10.1093/rheumatology/kew293
FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout [published correction appears in Arthritis Care Res (Hoboken). 2020 Aug;72(8):1187] [published correction appears in Arthritis Care Res (Hoboken). 2021 Mar;73(3):458]. Arthritis Care Res (Hoboken). 2020;72(6):744-760. doi:10.1002/acr.24180
Lin GL, Lin HC, Lin HL, Keller JJ, Wang LH. Association between statin use and the risk of gout in patients with hyperlipidemia: A population-based cohort study. Front Pharmacol. 2023;14:1096999. Published 2023 Feb 15. doi:10.3389/fphar.2023.1096999
Somagutta MKR, Luvsannyam E, Jain M, et al. Sodium glucose co-transport 2 inhibitors for gout treatment. Discoveries (Craiova). 2022;10(3):e152. Published 2022 Sep 30. doi:10.15190/d.2022.11
