Hyperuricemia and Arthralgias During Pyrazinamide Therapy in Patients With Pulmonary Tuberculosis

W. Qureshi, MD; G. Hassan, MD; S. M. Kadri, MPH, WHOFETP; G. Q. Khan, MD; Bensson Samuel, CT(ASCP); Ali Arshad, MBBS


Lab Med. 2007;38(8):495-497. 

In This Article

Materials and Methods

This study was conducted in accordance with the Institutional Review Board requirements for the conduct of clinical studies in the Department of Medicine, Government Medical College, associated with the SMHS Hospital, Srinagar, Kashmir, India.


The authors recruited 50 patients (22 females and 28 males), ages 15 to 64 years (mean ± SD, 34.8 ± 13.4), with active pulmonary tuberculosis based on history, clinical examination, and the results of diagnostic and laboratory studies, including chest radiography, sputum examinations for acid fast bacilli, erythrocyte sedimentation rate (ESR), tuberculin testing, enzyme-linked immunosorbent assay (ELISA) for surface antigens of Mycobacterium tuberculosis, and polymerase chain reaction (PCR) for Mycobacterium tuberculosis RNA. All patients underwent combination therapy with isoniazide, rifampicin, and PZA (20 to 30 mg/kg/da) for a minimum of 8 weeks. Ethambutol, because of its potential to cause hyperuricemia, was excluded in the treatment of these patients. All patients were evaluated for arthralgias based on self-reported signs and symptoms.

Exclusion Criteria

Patients with any disease likely to affect serum uric acid levels were excluded from the study, including those with hypertension, gout, diabetes mellitus, renal disease, hepatobiliary disease, cardiac disease, malignancies, or use of drugs that cause hyperuricemia or have a uricosuric effect.

Sample Collection, Storage, and Stability

Venous whole blood specimens were obtained by venipuncture from an antecubital vein at the same time of day (8:00 AM) from all patients. The blood was allowed to clot, the serum was removed and stored at 2B0C to 8B0C in tightly-capped tubes, and each tube was thawed once prior to uric acid testing.

Serum Uric Acid Determination

Uric acid (UA) was quantified in all serum samples using the uricase method in the Hitachi 916 automated chemistry analyzer (Hitachi, Japan). The reference range for this assay is 2.6 to 6.0 mg/dL for females and 3.5 to 7.2 mg/dL for males. The authors defined hyperuricemia as a serum uric acid concentration greather than the highest mean uric acid level (6.5 mg/dL) observed after 8 weeks of combination therapy.

Distribution of Patients

A subset of 13 patients who were treated with combination therapy for 8 weeks were discontinued on this therapy and begun on aspirin therapy (2.4 g/day in divided doses for 2 weeks).

Statistical Analysis

The data was analyzed using a paired Student's t-test and a chi-square test. A p-value less than 0.05 was considered statistically significant.


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