Should We Monitor Asymptomatic Hyperuricemia?
We invited gout expert Robert H. Shmerling, MD, to respond to Dr. Treuhaft’s questions. Click here to read Dr. Treuhaft’s letter first.
A Gout Expert Weighs In
Editor’s note: We invited gout expert Robert H. Shmerling, MD, to respond to Dr. Treuhaft’s? questions. Here is his response:
Thanks for asking. Short answer: There’s no reason now to screen populations for uric acid. That could change in the future.
My understanding is that screening uric acid was common in the past (e.g., the 1970s and before), but the Framingham data (among other epidemiologic studies) demonstrated that most hyperuricemic patients never developed gout or kidney stones, so the enthusiasm for screening (and treating asymptomatic hyperuricemia) has waned. So, it makes sense for the CMS and others to not encourage screening.
Longer answer: The questions to ask about screening for anything are: What would you do with the information? What disease/condition are you looking for? Is it treatable? Are there better ways to look for it?
Dr. Treuhaft seems to be asking not about gout but cardiovascular disease, and he may be on to something. There are some emerging data that are pretty compelling: Hyperuricemia may not just accompany renal insufficiency, cardiovascular disease, and metabolic syndrome—it may contribute to them. And, urate-lowering therapy might reduce the risk of these problems. However, as reviewed by both speakers at an ACR session on this last fall, it’s premature to extrapolate some small and preliminary studies to recommend screening (and treating) populations. Bigger and better studies could change the recommendations.
I would argue that, at the current time, there is no reason to screen for gout, kidney stones, cardiovascular disease, renal disease, or anything else by ordering uric acid tests because we are not at a point where anyone would recommend treating asymptomatic hyperuricemia. Plus, we have better ways to screen for cardiovascular disease, metabolic syndrome, etc.
Robert H. Shmerling, MD
Clinical Chief, Division of Rheumatology
Program Director, Rheumatology Fellowship
Beth Israel Deaconess Medical Center
Boston, MA
