Gout in Patients on Loop or Thiazide Diuretics
When gout develops in a patient who is concurrently taking loop or thiazide diuretics, the diuretic regimen itself is a clinically important factor in assessment and management. Addressing diuretic-induced hyperuricaemia is central to this scenario.
This protocol applies specifically to gout occurring in a patient who is receiving loop or thiazide diuretics. The concurrent use of these agents is a key driver of the clinical situation and must be considered in the management plan.
The approach centres on reviewing the offending diuretic and whether substitution is feasible — the appropriate alternative depends on the underlying indication for the diuretic. The complete structured regimen, covering the full set of considerations, is available via the protocol link below.
Reduction of serum uric acid level by eliminating diuretic-induced hyperuricaemia.
References
DOI: 10.1136/annrheumdis-2016-209707When gout occurs in a patient receiving loop or thiazide diuretics, substitute the diuretic if possible; for hypertension consider losartan or calcium channel blockers; for hyperlipidaemia, consider a statin or fenofibrate.
This recommendation is supported by a large epidemiological study finding relative risks of incident gout associated with the current use of calcium channel blockers and losartan of 0.87 (95% CI 0.82 to 0.93) and 0.81 (95% CI 0.70 to 0.94), respectively.
Finally, the uricosuric property of fenofibrate and statins has been further documented.
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