Category Archives: gout attacks

What are the triggers for gout attacks?

I’m often asked, “What can bring on a gout attack?”  The following are the classic triggers for gout attacks:

gout_0Medical illnesses such as congestive heart failure, blood clots in the legs, and pneumonia. Patients who eat too much or, conversely, go on a fast are also at risk.  Alcohol consumption, particularly beer, is a common trigger.

Dehydration, which is common in the summer, can bring on an attack.

Trauma or surgery are two important triggers. This is often seen in a hospital setting.

The treatment of gout to lower serum uric acid can also trigger an attack. This is probably due to shifts of uric acid within body tissues during the process of uric acid elimination.

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Why does gout cause attacks?

Gout is a disease due to the abnormal metabolism of purines, a substance found in many foods. Purines are converted to uric acid.   When the concentration of uric acid in blood rises above 6.8mg/dl, there is deposition of monosodium urate crystals in the joint.

gout_0Sites where monosodium urate deposits occur are in areas where there is a relatively low core temperature.  This decreases the solubility of uric acid.  Examples of such sites are peripheral cooler joints like the feet, elbow bursa, and the helix of the ear.

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Gout medicines and heart medicines conflict

Patients who take medications for both heart conditions as well as gout may have a problem with drug conflicts.

gout_0For example, thiazide diuretics cause an increase in serum uric acid.

Losartan (Cozaar) and fenofibrate (Tricor), often prescribed for cardiac patients have a dual effect.  While they block the reabsorption of uric acid in the kidney which causes serum uric acid levels to decrease, they are also metabolized by the cytochrome P450 enzymes in the liver.  The issue here is that gout drugs are also metabolized through this enzyme system and therefore their effectiveness may be decreased.

What’s a mother to do?

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Cherries reduce risk of gout attacks

A study published in Arthritis and Rheumatism showed that cherry intake decreased the likelihood of gout attacks. cherries

Researchers from Boston University, the University of Sydney, and the Royal North Shore Hospital in New South Wales studied 633 patients with gouty arthritis. They found that cherry intake over a two day period was associated with a 35% lower risk of gout attacks compared with no intake.

When cherry intake was combined with allopurinol use, the risk of gout  attacks was 75% lower.

For a long time cherries have been touted as a natural treatment for gout.  Conventional medicine has affirmed it. Gouty arthritis is not a benign disease and is often associated with other medical conditions such as obesity, hypertension, hyperlipidemia, and diabetes. These new findings are encouraging.

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