Diuretic effect on gout -
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search close. PREV Oct 1, NEXT. Clinical Question. Does the use of thiazide diuretics increase the risk of gout? Evidence-Based Answer. Evidence Summary.
Recommendations from Others. Copyright Family Physicians Inquiries Network. Second, in the study, alcohol use and dietary habits of patients may directly affect the SU levels.
But there is no detailed information on alcohol use and dietary habits of patients. All of these factors may have affected the results of the study. In these patients, although there are alternative anti-hypertensive drugs, the reason for the continuation of diuretics after diagnosis of gout is a matter to be discussed.
In conclusion, the results of this study, which can change our clinical practice, consisting of a retrospective and heterogeneous population, should be interpreted with caution. We believe that, as the authors emphasize, there is a need for prospective well-designed studies about the effects of diuretics on the necessary doses of ULDs to achieve the targeted SU level.
Rheumatology Department, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain. Universidad Miguel Hernandez de Elche, Alicante, Spain. We thank Tecer and colleagues [ 6 ] for their interest and considerations addressed around our article [ 1 ].
They discuss whether the approach in the diuretic treatment in patients with gout should be changed according to our results and whether dietary habits or other agents used for hypertension or dyslipidemia might have acted as confounders. The EULAR recommendations, in both the and versions, consider substituting diuretic therapy loop agents or thiazides when possible for the management of patients with gout [ 2 , 7 ].
Our findings suggest that this approach may be unnecessary, at least to achieve the proper SU target to ensure crystal dissolution. The rate of patients achieving stricter SU targets was also considerable.
Along with this, the dosage of the ULDs was comparable between groups. We agree with the authors that these findings should be replicated in prospective controlled studies, but, in view of our results and recent reports [ 8 ], diuretics could be maintained. Certainly, the indication for diuretics may drive the decision.
Whether diuretic withdrawal has an impact on future ULD maintenance dosing, in order to prevent the formation of new urate crystals, remains to be explored. Alcohol and dietary intake were not registered in clinical records, but lifestyle advice is routinely given to all patients with gout and not led by whether they were on diuretics or not.
The use of other agents with uricosuric action, such as calcium channel blockers, losartan, atorvastatin, or fenofibrate, was not registered. In our experience, their urate-lowering effect is modest, especially when they are combined with ULDs [ 9 ]. Following this, we do not routinely use them when we initiate ULDs.
Thus, their impact on our study findings appears to be limited. Ranieri L, Contero C, Peral ML, Calabuig I, Zapater P, Andres M.
Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort. Arthritis Res Ther. Article Google Scholar. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J, et al.
Ann Rheum Dis. Article CAS Google Scholar. Choi HK, Soriano LC, Zhang Y, Rodriguez LA. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study.
Derosa G, Maffioli P, Sahebkar A. Plasma uric acid concentrations are reduced by fenofibrate: A systematic review and meta-analysis of randomized placebo-controlled trials.
Pharmacol Res. Ogata N, Fujimori S, Oka Y, Kaneko K. Effects of three strong statins atorvastatin, pitavastatin, and rosuvastatin on serum uric acid levels in dyslipidemic patients.
Patients were from medical centers in North America between and The study notes that atenolol use was reported by participants at the 1-month visit. Results indicate that, over a mean follow-up of 4. This finding may be useful in cases where gout risk is a principal concern among patients being treated for hypertension.
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The pathogenesis, epidemiology, and an overview of Diudetic of diuretic-induced hyperuricemia and Post-workout nutrition are gput in this effedt. The Diuretic effect on gout, clinical manifestations, diagnosis, and treatment of gout flares as well as the prevention of gout flares are discussed separately:. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. Diurtic details. Effect Letter to Diuretic effect on gout article was published on 26 October Diuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs ULD and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout. This was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed.
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