Pyrazinamide Hyperuricaemia — SCE Infectious Diseases MCQ

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EasyTuberculosisPyrazinamide HyperuricaemiaSCE Infectious Diseases

A 50-year-old man with TB is started on standard RHZE. At week 2, his uric acid rises to 650 µmol/L and he develops a gout flare in his right first MTP joint. Which TB drug caused the hyperuricaemia?

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Correct answer: D — Pyrazinamide — it inhibits renal urate excretion, causing hyperuricaemia in virtually all patients

Pyrazinamide inhibits renal tubular secretion of uric acid, causing hyperuricaemia in nearly all patients (dose-dependent). Symptomatic gout occurs in a minority. Management: mild asymptomatic hyperuricaemia does not require treatment; symptomatic gout is treated with Colchicine or NSAIDs (NSAIDs should be used cautiously with hepatotoxic TB drugs). Allopurinol can be used for recurrent episodes. Pyrazinamide-induced hyperuricaemia resolves when the drug is stopped after the 2-month intensive phase. It is not an indication to stop Pyrazinamide early unless gout is severe/recurrent.

Reference: BNF 2024 – Pyrazinamide; NICE NG33 2016 – TB