title: Treatment of asymptomatic hyperuricemia for the prevention of gouty arthritis, renal disease, and cardiovascular events: a systematic literature review.
abstract: OBJECTIVE
  To systematically review available literature on treatment of hyperuricemia (HU) as a measure of preventing gouty arthritis, renal disease, or cardiovascular events in asymptomatic patients.
  
  
  METHODS
  A systematic literature search was conducted in the Cochrane Library, Medline, Embase, clinical trials registries of the World Health Organization and the US National Institutes of Health, and abstracts from American College of Rheumatology/European League Against Rheumatism meetings, for interventional studies involving adults with no history of gouty arthritis, who were treated for HU. Outcomes of interest included gouty arthritis, renal disease (i.e., renal insufficiency, urate nephropathy, nephrolithiasis), and cardiovascular events (i.e., myocardial infarction, heart failure, ischemic stroke).
  
  
  RESULTS
  A total of 3 studies met the inclusion criteria, 2 studies assessing the prevention of renal disease and 1 study evaluating the potential for delaying progression of preexisting renal disease. In hyperuricemic patients without renal disease, treatment resulted in increased estimated glomerular filtration rate. In hyperuricemic patients with preexisting renal disease, treatment resulted in no significant elevation of serum creatinine over a 1-year followup. However, differences in renal function between the treatment and no-treatment groups were not statistically significant in any of the identified studies.
  
  
  CONCLUSIONS
  Very limited data are available on the treatment of HU in asymptomatic patients. There is currently insufficient empiric evidence to suggest that lowering serum uric acid level in asymptomatic patients with HU can prevent gouty arthritis, renal disease, or cardiovascular events.
authors.affiliation: From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital. ophir.vinik@utoronto.ca.
authors.forename: Ophir
authors.initials: O
authors.lastname: Vinik
authors.affiliation: From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital.
authors.forename: Mihir D
authors.initials: MD
authors.lastname: Wechalekar
authors.affiliation: From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital.
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.affiliation: From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital.
authors.forename: Désirée M
authors.initials: DM
authors.lastname: van der Heijde
authors.affiliation: From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital.
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
mesh_terms: D015210:Arthritis, Gouty / Q000188:drug therapy / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy*; D007674:Kidney Diseases / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome; D014528:Uricosuric Agents / Q000627:therapeutic use*
chemical_list: D014528:Uricosuric Agents
keywords: ASYMPTOMATIC; GOUTY ARTHRITIS; HYPERURICEMIA; PREVENTION