Elevated urate levels linked to musculo-skeletal pain

Episodes of diffuse musculo-skeletal pain appearing in and around a joint region without a clear diagnosis, etiology and therapy are still a major problem in general medical practice. Our cross-sectional study addresses the question of whether slightly elevated urate levels are associated with musculo-skeletal pain.

While the usefulness of urate-lowering treatment in patients with clinical manifestations of hyperuricemia has been established, its use in asymptomatic hyperuricemia is still the object of several controversies. Nevertheless evidence rises for uric acid in non-gouty patients to be an independent cardiovascular and metabolic risk factor. Asymptomatic hyperuricemia is both associated with as well as a predictor of hypertension, renal deficiency and diabetes. Therefore, uric acid is increasingly seen as part of the metabolic syndrome.

Since evidence for subclinical musculo-skeletal involvement in otherwise asymptomatic individuals with hyperuricemia is lacking, urate lowering therapy to date is only indicated and reimbursed in cases of confirmed gout. Current international guidelines do not address the pharmacologic management of asymptomatic hyperuricemia due to a paucity of prospective, randomized, controlled intervention trials in that area. Still, there are no data available how many patients with asymptomatic hyperuricemia have to be treated to prevent one patient with gout (number needed to treat/number needed to harm). However, in a cross-sectional controlled study, ultrasound findings demonstrate the signs of present monosodium urate crystal tissue deposition in both intra- and extra-articular structures from asymptomatic hyperuremic individuals.