Hyperuricemia is Associated with Musculo-skeletal Pain - Results from a Cross-sectional Study

Hans-Ulrich Comberg1, *, Siegfried Schach2
1 General and Family Medicine, Jürgensallee 42 22609 Hamburg, Germany
2 Department of Statistics, TU Dortmund 44227 Dortmund, Germany

© Comberg and Schach; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the General Family Medicine, Jürgensallee 42, 22609 Hamburg, Germany; Tel: ++49 40 823534; E-mail:



The use of urate lowering therapy in patients without gouty arthritis and slightly elevated uric acid levels (so called “asymptomatic” hyperuricemia) is still under debate.


This study explores whether slightly elevated urate levels are associated with musculo-skeletal pain.


This cross-sectional study was conducted in a single German center. Generally healthy subjects (including patients with controlled mild hypertension, hyperlipidemia, and/or not insulin dependent type 2 diabetes) aged 20-75 years presenting for their annual routine check-up were invited to participate. Documented parameters included a full blood count, blood pressure, weight, height, prescribed medication, purine and alcohol intake, and pain assessment during the two preceding years.

The sample size was determined by the requirement that in comparing major groups (such as men vs. women, hyperuricemia vs. normal uric levels) a difference between these groups in an attribute (such as joint pain) should be discovered with a probability of at least 90 percent.


In total, 600 patients (54.7%) male, (55.2% ± 13 7 years) were included in the survey. Urate levels were closely correlated to the number of patients complaining about joint pain (r=0.978). Higher urate levels were associated with a higher percentage of patients with joint pain. There was a marked increase in the percentage of patients experiencing joint pain from urate level 5 (30.8%) to 5.5 (60.9%). Lumbar spine, cervical spine, shoulder, and knee were the most common locations for joint pain. Multivariate analysis indicated weight, purine intake, alcohol consumption, administration of diuretics, creatinine, and triglycerides as factors with significant impact on the urate level. Of all tested variables, only serum urate had a significant impact on joint pain (OR 1.996; 95% CI 1.626-2.451; p<0.0001). A significant correlation between pain in various joints and urate levels was found for all most commonly affected regions.


In this population of generally healthy subjects presenting for their annual routine check-up, results indicate the possibility of a significant impact of urate levels on joint pain.

Keywords: Asymptomatic hyperuricemia, Gout, Musculo-skeletal pain, Serum urate.