Management of hyperuricemia and gout in obese patients undergoing bariatric surgery

BACKGROUND: Hyperuricemia and gout represent important issues in the obese patients. Considering the epidemic trend of overweight and obesity in developed countries, the impact of these conditions is likely to increase. At present, bariatric surgery represents the most effective treatment for the management of severe obesity for reducing weight and the impact of associated comorbidities, but its effects on hyperuricemia and gout have not been fully elucidated. METHODS: In this narrative review, we discuss the current knowledge about hyperuricemia and gout in obese patients undergoing bariatric surgery. We also suggest a useful approach to prevent gouty attacks in the perioperative period. RESULTS: Weight loss seems to reduce hyperuricemia in the long-term follow-up, but there is evidence also of a high frequency of acute attacks early after surgery in patients with a diagnosis of gout. CONCLUSION: Bariatric surgery has a high impact on hyperuricemia and gout. A perioperative approach is suggested, based on appropriate hydration, early physical resumption, urate lowering drugs and nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine and corticosteroids if NSAIDs are ineffective or not tolerated.