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. 

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The serum uric acid level in all patients (n = 50) prior to the initiation of combination therapy ranged from 2.6 mg/dL to 5.4 mg/dL (mean ± SD, 4.4 ± 0.5 mg/dL). Moreover, there was a progressive increase in serum UA concentration over the 8-week period of combination therapy in all patients, with levels rising significantly between weeks 4 and 8 compared with pretreatment levels of UA ( Table 1 ). Among these patients, the prevalence of hyperuricemia was 48.0% (24 of 50). One patient had hyperuricemia (UA concentration = 7.1 mg/dL) after the 4th week of combination therapy. At the end of the 8-week period of combination therapy, 11 of the 50 (22%) patients complained of arthralgias, especially in the knee ( Table 2 ). In the patients (n = 13) who were treated with combination therapy for 8 weeks and then discontinued on this therapy and begun on aspirin therapy for 2 weeks, the serum UA levels in all of these patients returned to normouricemic levels (ie, < 6.5 mg/dL), consistent with their pretreatment levels, from their hyperuricemic levels (> 6.5 mg/dL) at the end of 8 weeks of combination therapy ( Table 3 ). Moreover, in patients (n = 11) treated with combination therapy for 8 weeks and subsequently discontinued on this therapy for 2 weeks, UA levels were significantly higher at 8 weeks post-therapy versus pretreatment levels and returned to pretreatment levels after discontinuation of this therapy ( Table 4 ).


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