Johns Hopkins Health Alert
Can Gout Cause a Heart Attack and other Questions
In this Health Alert, Dr. Joan M. Bathon answers reader's questions about living with gout.
Q. I am a 51-year old man with a history of gout. Three weeks ago, I had a flare up of gout, with all the classic symptoms. The main joint on my big left toe had the most pain. My doctor prescribed colchicine. I have been taking .6 mg of colchicine a day as prescribed. I have also been drinking a lot of water, watching what I eat, and eliminated all beer.
Now that my symptoms have gone away and I have not had any new attacks, my foot still doesn't feel 100%. There seems to be some residual pain and my foot/toe seems very susceptible to injury. I have stubbed it a couple of times, which seems to cause a lot of lingering pain, although there has been no real gout flare up. Is this normal? Is it possible that one gout attack could cause joint damage? On the other hand, am I just not getting over the gout attack completely for some reason? Is a joint more sensitive to injury after a flare up? Thanks for your help. Princeton, NJ
A. Most gout attacks resolve within a few days. Medication can shorten the gout attack. Over time, though, if preventative medication (allopurinol) isn't used, the attacks tend to become more frequent and last longer and longer until they all run together in one continuous state of joint inflammation. At this stage, we refer to gout as "chronic" rather than "acute." In general, if an individual is having multiple attacks of gout per year, we will recommend the use of allopurinol. Currently, this is the most effective medication for lowering uric acid in the blood.
Uric acid is the chemical that causes gout. When levels of uric acid get too high, the uric acid crystallizes in the joint causing the inflammation. Allopurinol shuts down the body's ability to make uric acid, thus markedly reducing the possibility of developing any more gout attacks. Colchicine reduces inflammation but does not lower uric acid. Folks having repeated attacks of gout, or an attack that just won't quit, should consult with their primary care physicians for treatment recommendations.
Q. I was recently diagnosed with gout and my doctor told me that I have to keep it under control, not just to prevent the painful flares but more importantly because gout can increase the risk of having a heart attack. I had never heard of this before. How can a sore toe cause a heart attack? Hanover, NH
A. Many inflammatory conditions outside the heart are associated with a higher risk for developing heart attacks and strokes. Rheumatoid arthritis and lupus are the best examples of this. We think it is because these are systemic diseases in which highly inflammatory molecules are circulating around in the bloodstream, and may promote atherosclerosis as they bathe the heart day after day, year after year.
Gout may present a similar picture since uncontrolled gout consists of repeated bouts of inflammation. In addition, when one looks at folks who have heart disease, even without symptomatic gout, a high uric acid level (uric acid is the chemical that causes gout) is associated with a higher risk of heart disease. So, if you have gout, you should make sure it is kept under control, both for the sake of preserving your joints and perhaps for preserving a healthy heart, too.
Posted in Arthritis on May 25, 2009
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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I am a 66 year old mail. Contacted gout in my 40's. When Dr.'s wanted to keep me on allapuronal the rest of my life so OI started to look for a alternate cure. Found that concentrated black cherry juice would do the trick. Have not been bothered with gout in 20 yrs. unless I forget my cherry juice. Get your concentrated cherry juice at a health food store. The brand I use comes in a glass jar and the brans is Natural Sources. I swear by it.
Posted by: hipbreak | May 30, 2009 12:48 PM
Rheumatologists are the recognized gout experts. Yet they always seem to find excuses for not following up on the pulmonology journal literature that describes how sleep apnea can cause a gout attack upon awakening. The oxygen reduction caused by the periods of no breathing while sleeping has two effects which can lead to a gout attack. First, it causes the cells to begin a process of disintegration (catabolism) which leads to their generation of excess uric acid fed into the blood. Second, the reduced blood oxygen level makes the blood more acidic so that its ability to hold uric acid in solution is reduced. The result is that uric acid precipitates out of the blood in the form of urate crystals. When these crystals lodge in a joint, they cause the immune system to react with the severe pain and inflammation of gout. ANYONE WHO SUFFERS FROM GOUT SHOULD BE SCREENED FOR SLEEP APNEA. PROPER TREATMENT OF SLEEP APNEA WILL GREATLY REDUCE YOUR RISK FOR THE DEVELOPMENT OF LIFE-THREATENING DISEASES THAT ARE KNOWN TO RESULT FROM IT OVER THE LONG TERM, INCLUDING HEART ATTACKS, STROKE, DIABETES, ETC. YOUR GOUT IS YOUR EARLY WARNING!
Posted by: Burt Abrams | May 31, 2009 7:51 AM
Is it not correct that the cause of gout is associated with too much uric acid? Could it be the person suffering from gout is simply lacking in adequate ingestion of water for their body weight to flush the excess uric acid and metabolic waste out of the body? Would not properly hydrating one's body with alkaline water be a more effective protocol than medications, which in themselves further acidify the body?
Posted by: smputney | May 31, 2009 4:58 PM
Is it not correct that the cause of gout is associated with too much uric acid? Could it be the person suffering from gout is simply lacking in adequate ingestion of water for their body weight to flush the excess uric acid and metabolic waste out of the body? Would not properly hydrating one's body with alkaline water be a more effective protocol than medications, which in themselves further acidify the body?
Posted by: smputney | May 31, 2009 4:59 PM
In the past two years I have had two gout attacks, one in my left elbow and the other in the right elbow. After taking medication to relieve the pain in both cases a pre-scheduled PSA was due to monitor my prostate cancer within a week after the attacks. This PSA schedule had nothing to do with the attacks. The PSA score in both cases doubled. Is there a relationship between gout and the high PSA scores? After the first attack two years ago the PSA score went down over a period of time.
Four years ago I had both hips replaced due to arthritis and my fingers
are also in poor condition.
Posted by: Rsiblo | June 1, 2009 3:53 PM
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My last gout flare up was 3 years ago after half a beer and mackerel, I took allopurinol for a while but had to stop since it raised my blood glucose. (% uncles and a cousin died from Diabetes complications). I changed my diet drastically mainly fruits vegetables, whole grtain and a finger of meat or fish from time to time. I take-in a spoon of dry parsley because it is the highest apigenin content of anything around against uric acid. My uric acid is till high but not enough to cause a bout of Gout. What else can I do to lower the uric acid further?
Posted by: Albert Reingewirtz | May 30, 2009 8:29 AM