Individuals with Hyperuricemia Tend to Use More Analgesics Compared to Those with Normal Uric Acid Levels—Is Asymptomatic Hyperuricemia Truly Without Symptoms?

By
Janis Timsans
Jenni Emilia Kauppi
Vappu Rantalaiho
Anne Kerola
Kia Hakkarainen
Tiina Lehto
Hannu Kautiainen
Markku Kauppi
December 11, 2025
0 min

Bmc Medicine

Overview

This study found that individuals with hyperuricemia, even without gout attacks, tend to use more analgesics including NSAIDs, paracetamol, and opioids over an 11-year period compared to those with normal uric acid levels. The association was influenced by renal function, with metabolic hyperuricemia showing a stronger link to analgesic use than renal hyperuricemia.

Background

Uric acid is the final product of purine metabolism and can crystallize to cause gout, a condition treated with anti-inflammatory agents. However, many gout patients also use non-anti-inflammatory pain medications, including opioids. Elevated serum uric acid (SUA) is a risk factor for gout but many with hyperuricemia remain asymptomatic. Recent evidence suggests asymptomatic hyperuricemia is associated with musculoskeletal pain and cardiometabolic risks. Renal function modifies the impact of uric acid, distinguishing metabolic from renal hyperuricemia.

Data Highlights

Group	SUA Level	Renal Function (eGFR)	Analgesic Use
Normouricemic	≤360 μmol/L	All	Lower analgesic purchases
Hyperuricemic - Metabolic	>360 μmol/L	>67 ml/min/1.73 m2	Higher analgesic purchases
Hyperuricemic - Renal	>360 μmol/L	≤67 ml/min/1.73 m2	Less increase in analgesic use compared to metabolic

Key Findings

Individuals with hyperuricemia purchased significantly more analgesics over 11 years than those with normal SUA levels.
Both NSAIDs and opioids were more frequently used by hyperuricemic participants, indicating pain management beyond inflammatory gout flares.
Metabolic hyperuricemia (high SUA with normal renal function) was associated with greater analgesic use than renal hyperuricemia.
Self-reported pain intensity and interference correlated with higher SUA levels, supporting symptomatic burden in asymptomatic hyperuricemia.
Analgesic use data provide objective evidence of symptomatology in hyperuricemia beyond patient recall bias.

Clinical Implications

Clinicians should recognize that elevated serum uric acid levels may be associated with increased pain and analgesic requirements even in the absence of diagnosed gout. Assessment of renal function is important to differentiate metabolic versus renal hyperuricemia, as this influences symptom burden and analgesic needs. These findings suggest reconsideration of the 'asymptomatic' label for hyperuricemia and highlight the need for comprehensive pain evaluation and management in these patients.

Conclusion

Hyperuricemia is linked to increased analgesic use, indicating symptomatic manifestations beyond classic gout attacks. Renal function modifies this relationship, underscoring the clinical relevance of differentiating hyperuricemia subtypes.

References

GOAL Study / Päijät-Häme Region / 2002-2013 -- Analgesic Use and Serum Uric Acid Levels
CKD-EPI Creatinine-Cystatin C Equation / 2012 -- Estimation of Renal Function