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European Journal of Heart Failure 2002 4(4):403-410; doi:10.1016/S1388-9842(02)00086-7
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© 2002 European Society of Cardiology

The management of hyperuricemia and gout in patients with heart failure

Lukas E. Spieker, Frank T. Ruschitzka, Thomas F. Lüscher and Georg Noll*

Department of Cardiology University Hospital, Zürich, Switzerland

* Corresponding author. Tel.: +41-1-255-2182; fax: +41-1-255-4597; Homepage: www.kardiologie.unizh.ch E-mail address: karnog@usz.unizh.ch

Received October 19, 2000; Revised August 29, 2001; Accepted October 23, 2001

The first 150 words of the full text of this article appear below.


   1. Introduction
 
Gout is a clinical syndrome resulting from the deposition of urate crystals in joints causing inflammation, intense pain, and even disability to patients. Patients with chronic heart failure frequently present with hyperuricemia. In these patients, the management of gout can raise specific problems. Cardiovascular risk factors such as hypertension and hyperlipidemia are associated with elevated urate levels and are frequently present. Chronic renal failure, which often complicates the pharmacotherapy of heart failure, is also associated with hyperuricemia. Diuretics, which are invariably needed for the treatment of volume retention, increase uric acid levels. The treatment of gout in patients with heart failure is complicated by their fragile volume state and chronic renal failure, both of which prohibit the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Moreover, drug interactions exist between drugs used for the treatment of hyperuricemia and gout and pharmacological agents used for the therapy of heart failure. This . . . [Full Text of this Article]


   2. Uric acid
 

   3. Hyperuricemia
 
3.1. Hyperuricemia and heart failure
3.2. Drug-induced hyperuricemia
3.2.1. Diuretics
3.2.2. ACE-inhibitors
3.2.3. Angiotensin receptor antagonists
3.2.4. Other drugs

   4. Pathophysiology of gout
 
4.1. Gouty arthritis
4.2. Tophi
4.3. Gout and renal disease

   5. Treatment of gout
 
5.1. Acute gouty arthritis
5.1.1. NSAIDs in chronic heart failure
5.1.2. Selective COX-2 inhibitors
5.1.3. Colchicine
5.1.4. Further therapeutic measures in patients with heart failure
5.2. Chronic gout
5.3. Allopurinol
5.4. Uricosurics

   6. Conclusions
 

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