121 SHOULD DIETARY RESTRICTIONS ALWAYS BE PRESCRIBED IN THE TREATMENT OF GOUT?

Abstract

Primary gout is commonly associated with other metabolic disorders such as obesity, arterial hypertension, hyperlipidemia and diabetes mellitus that usually require a dietary regimen. However, long-term compliance to dietary restrictions may be rejected by subjects with a chronic disease and a peculiar tendency for purine-rich food. Among 175 patients with primary gout, 133 (76%) had associated metabolic disorders: 75 were obese (43%), 63 had arterial hypertension (36%), 67 showed hypercholesterolemia or hypertriglyceridemia (38%) and 10 had diabetes mellitus (6%). Besides gout, 42 patients (24%) had no other metabolic derangements requiring dietary intervention. In these patients a purine-restricted diet (< 75 mg/24 h of purines) for 5 days diminished the serum urate concentration from a base-line value of (mean±SEM) 8.9±0.2 to 7.2±0.2 mg/dl (P< 0.001) and uric acid excretion from 792±53 to 478±29 mg/24 h (P < 0.001). The administration of allopurinol (300 mg/24 h) for 5 days, while patients were on a self-selected diet, reduced serum urate to 5.4±0.1 mg/dl (P<0.001) and uric acid excretion to 374±22 mg/24h (P<0.001). These data indicate that allopurinol normalises uric acid metabolism in patients with primary gout who had no associated metabolic disorders, despite the intake of a self-selected diet.