Is Gout Dangerous?


The overwhelming belief by most doctors is that gout is a relatively benign disease – that is, it may cause a lot of pain but really doesn’t do any real damage.  Unfortunately, this belief is wrong.  Gout is dangerous in a couple of ways. First, in the damage that gout attacks cause directly.  Second, in the underlying cause of gout, a condition called hyperuricemia – a condition associated with many very serious and life-threatening diseases.

The Damage of Gout Attacks

As described in one of my previous post, Gout Basics, gout is caused by an immune response to uric acid crystals that form in the joints.  This immune response causes much inflammation which is the actual source of pain in a gout attack.  This inflammation also damages the joint slightly.  If gout is not properly managed, over the course of years and many gout attacks, this damage can accumulate and cause constant pain in the joint, limiting of the mobility of the joint (the joint will become stiff and painful to move), it can cause boney changes in the joints called punch-out lesions (where the bone grows in abnormal ways) and ultimately, it can cause the joint to become completely immobilized.

Now at this point I should point out that this does not happen in all cases of unmanaged gout.  If you have only occasional attacks (1 or 2 a year), then it will take a lot longer for this damage to build up. If your gout attacks are even less frequent, this damage may never accumulate to the point where any long-term damage occurs. However, for many people, this damage is a significant risk if you do not get your gout under control.

The other danger of unmanaged gout is tophus.  Tophi (plural for tophus) are collections of uric acid crystals that can form in the body.  These tophi usually form around a joint (most often the ones where you have most of your gout attacks) and around the helix of the ear (the outer rim of the ear) but can form anywhere, even in your heart, which can be very dangerous (fortunately, this is rare).  These tophus can become very large and cause serious disfigurement of the hands, feet, elbows and knees where they are most common.  They can also cause the skin above them to die or rupture resulting in uric acid crystals oozing out and can easily result in infection.

The key to avoiding these problems is to control your uric acid level.  Uric acid can not crystalize if the level of uric acid in the body is kept below 6.8mg/dL (378µmols/L) so lowering your uric acid level to below 6mg/dL (333µmols/L) will stop gout attacks, prevent tophus from forming, dissolve any existing tophus and prevent any further damage from occurring.  Unfortunately, one recent study found that as many as 78% of doctors do not properly treat gout.  If you have gout, you really should educate yourself about gout treatments and the proper methods of managing this disease.

The Dangers of Hyperuricemia

If that sounds scary, just wait – hyperuricemia, the underlying cause of gout has been linked to many of the most dangerous diseases that plague our society today including heart disease, high blood pressure, kidney disease, liver disease, diabetes, stroke and obesity.  What’s worse, is that the research has shown that lowering your uric acid will only slightly reduce your risks for developing these diseases.  It’s not fully understood how hyperuricemia is related to disease but it is believed that it is the result of constant inflammation caused by the crystallization of uric acid in the body over the course of decades.

Hyperuricemia means having high levels of uric acid everywhere in your body, not just the joints or in the blood.  This means that even if your blood uric acid level (what the doctor will check to find out your uric acid levels) is below 6mg/dL (333µmols/L) as recommended, there may still be “pools” of uric acid in your body at higher concentrations which are forming crystals and causing inflammation even if they are not causing any gout attacks.  Research is being done to shed more light on the exact mechanism by which hyperuricemia causes disease.  Regardless, if you have gout, you have hyperuricemia and you are at risk.

What’s worse, is that the risk of developing deadly disease is extremely high in those with hyperuricemia.  One study showed an 852% increase in the risk of kidney failure over just five years:

Risks of various diseases based on uric acid level.

Risks of various diseases based on uric acid level.

Now it’s important to point out that statistically, an increase in risk of 30-40% is considered significant so an increase of risk by 200-900% are almost unheard of.  In other words, if you have hyperuricemia, even if you do not have gout, you are at severe risk of developing these diseases!

To make things ever more scary, most doctors are completely unaware of the correlation between hyperuricemia and disease.  The research exposing these risks is fairly new and has not made it into the ‘collective medical consciousness’.  In the past, it was believed that high levels of uric acid where somewhat beneficial because uric acid is a weak anti-oxidant.  Unfortunately, most doctors still believe this.

Now I need to point out that we do not fully understand what’s happening here. There is a strong corolation between hyperuricemia and disease but we do not know for sure if hyperuricemia causes disease. Just that if you have it, you are at much higher risk of disease.

Lastly, your doctor might not even be aware that your uric acid level is too high.  There is no defined, agreed upon range for what are “normal” uric acid levels.  Because of this, most labs simply take all the results of all the patients they test and define a range around the average (one standard deviation above and below, if you are wondering) and define that as “normal”.  Since as many as 30% of people are hyperuricemic, this skews the “normal” range upward.  My lab reports came back showing levels as high as 8.5mg/dL (472µmols/L) as being “normal” but this level is much too high. More than high enough to cause gout and more than high enough to correlate with disease.

What should I do to prevent disease?

Well, the only way we know of to prevent the diseases associated with hyperuricemia, or at least reduce them are to eat a well-balanced, reduced-calorie diet and exercise regularly (see ‘The ‘Skinny’ on Gout Diets’) and if you are over weight, loose that weight now! Fortunately, this will also be very good for your gout.  Unfortunately, very few people make these changes and even less stick to them.


If you liked this post, you will love the book, Beating Gout: A Sufferer’s Guide to Living Pain Free. Get the whole story in one easy-to-understand book, get your copy of Beating Gout: A Sufferer’s Guide to Living Pain Free now. Over 500 research articles and texts where studied and dozens of world class experts on gout were interviews for this book yet it is written for the non-expert. No other book on gout is more up-to-date, comprehensive or easy-to-understand – guaranteed!

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  1. #1 by Chris on April 7, 2009 - 1:03 pm

    Hi, firstly I really like your blog and the information provided.

    I was firts diagnosed with gout when 22, yes 22! My doctor couldn’t believe it either… I am now 32 and in those 10 years I’ve probably had 3 or 4 really bad attacks and a handful of smaller ones.

    What I get annoyed with is that I am lean (11% body fat), haven’t had alcohol in months, I do intense excercise 4-5 times a week, I’m not old, I eat a well balanced organic diet meaning I should be less chance to get an attack. Right?

    Well not so as right now my ankle is very swollen and I am struggling to walk, which annoys me no end because I can’t excercise or go to work.

    I was initially (when I was 22) prescribed allipurinol and indomethicin (spelling?) which worked but there was no way I was taking a pill a day for life.

    Since then I’ve been in search of a natural way of conroling this condition as I don’t like the sounds of the results of letting it go unmanaged but I also don’t like not knowing what long term effect prescription drugs can have on my body.

    Anyway, I have bought the book and I continually read everything I can on the subject in the hope of finding a natural alternative that works for me.

    This was a long winded way of saying thanks, and keep up the good work!

  2. #2 by Victor Konshin on April 7, 2009 - 1:35 pm

    Chris,

    Thanks for the comment. I am concerned about the fact that you had your first gout attack at age 22. That is way too young. Has your doctor checked for a secondary cause of gout? Some of these can be dangerous including cancer and kidney diseases. Since you said you have a copy of my book, there is a list of many causes of secondary hyperuricemia in chapter 4.

    Also, I am curious about how your gout was diagnosed. If it was diagnosed by its symptoms and not by looking for crystals in the synovial fluid, then it could be pseudogout or some other form of crystal arthritis (see the end of chapter 3).

    If you are confident that it is gout, then medications are the best way to manage gout. Allopurinol has a good track record if you are not allergic to it. Since you have already taken it, you know that you are not. Also, probenecid also very safe but you need to watch out for kidney stones.

    The thing that bothers me about most alternative medicine solutions is they often target the inflammation and not uric acid levels, they often have little scientific evidence behind them and they often have just as many risks as the prescription medications that are available, sometimes more.

    I am working with some doctors to develop a vitamin supplement that I think will be much more effective than what is out there but at this point I do not know when or if this product will become available.

    -Victor Konshin

  3. #3 by Chris on April 7, 2009 - 11:02 pm

    Thanks for the reply, yeah such a young age worries me too, because all you here is “usually affects men 35+”.

    The initial symptoms were a very inflamed big toe, so my doctor ordered a blood test thinking it might be gout but unlikely. My uric acid levels were high and hence the diagnosis of Gout, the anti inflammatorys helped and the Allipurinol works. If I take Allipurinol I do not get gout attacks. So I think I just need to suck it up for now and take it, whilst trying to find alternatives.

    I haven’t read your book as yet, it’s on order. I also haven’t been checked for secondary causes of gout… although that blood test at 22 I did get all sorts of things tested and my kidney and liver were functioning fine. However maybe I do need to get some tests done just to make sure there’s no other problems…

    I also had a bad attack last year, I went to the doctors and had another blood test, the uric acid levels were again high, can’t remember how high but I think around 10+. So I’m pretty sure it’s Gout as it’s been confirmed a few times by different doctors.

    What also worries me, is that I’ve had swelling in a few different joints, big toe, ankle and elbow.

    Anyway, for now it’s back on the medication and do more reading and learning to see if there are alternatives.

    Are there proven long term side effects of prolonged Allipurinol use that you know of? Am I worried about if for no reason?

  4. #4 by Victor Konshin on April 8, 2009 - 1:07 pm

    Chris,

    I will send you a direct e-mail…

    -Victor Konshin

  5. #5 by Sal C on April 20, 2009 - 3:40 pm

    Hi Victor,
    I just came across your blog. I am 45 and had gout for about 10 years. Most of my gout attacks lately been medium, I usually manage my gout attacked with combination of colcochin(sp) and NSAID. About a week ago I had heart attack. I had clean bill of health about three months back on my yearly physical. I work out 4/5 times a week, I am 5’11 about 175lbs, so clearly not over weight, all my vital signs normal. I am finding out that there appears to be a link between gout and heart attack. Have you heard of such? I am confused of my heart attack, I don’t have family history of any heart problems either. I follow a healthy diet, don’t drink or smoke. Thanks

    Sal C

  6. #6 by Victor Konshin on April 22, 2009 - 11:15 am

    Sal,

    It is possible that the NSAIDs contributed to your heart attack. Which NSAIDs where you taking and at what dose?

    NSAIDs should be taken at a high dose for gout attacks but for the shortest length of time possible. No more than two days for indomethacin.

    -Victor Konshin

  7. #7 by Bruce Thomas on April 23, 2009 - 6:17 pm

    I had been prescribed 2 medications that cause a high uric acid concentration. I had asked a couple times to stop taking them because I was shakey and one did not seem to do anything other than make my stomach upset. Well within 2 years developed Gout, but found this combination. Colchine 7 tabs day one 5 day two, 4 day three and then 2-3 coupled with Advil or Aleve on the first few days which completely knocked out an established attack that had lingered 30 days in a day and a half.

    The severe attack started while on the medications, but became severe when stopping them. The doctor told me to stay on NSAIDS for three months before taking a blood test which he expect to come out normal, but desolving causes Gout and is prolonged. The worst thing is when stopping the medications that caused it I had Gout in all toes, my ankle, my knee, my wrist and well put it this way, the took me in the doctors and gave me a wheelchair. Fortunately the doctor did not prescribe the drugs but looked at my uric acid tests at 14 during an attack and immediately said to stop the medications which I had already done. I had gone in a month earlier in severe pain which migrated all over quickly. I was angry that those doctors defended medication that raised uric acid levels to potentially endangering levels.

    Coupled at first with Norco to kill pain and to allow sleep. I was amaized that the attack went away after 30 days in 1 day. I am to back of the Ibuprofen within 3 days and stay on a low dose of colchine to prevent attacks while the crystals desolve which takes a while. The only good thing over the 30 days I have not been hungry and lost 15lbs, but I know am a firm believer in checking side effects of medications before agreeing to take them.

  8. #8 by Sal C on April 26, 2009 - 10:46 am

    Hi Victor,
    I was not taking high dosage of NSAID’s, I was taking may be three or four 200 mgs a day when needed. But I have another problem now; I was given Plavix after my heart attack. This weekend I have a severe case of gout. I came across articles linking Plavix to gout attack. I plan to go see a doctor Monday or as soon as I can. I hope something can be done. I need Plavix for my heart condition (at least that’s what my cardiologist told me). Thanks for your time.

    Sal C

  9. #9 by Victor Konshin on April 27, 2009 - 12:40 pm

    Bruce,

    It does not sound like your doctor has not put you on any medication to lower uric acid levels. NSAIDs and Colchicine will mask symptoms but not control uric acid levels. Lowering uric acid levels is the only way to stop the attacks.

    -Victor Konshin

  10. #10 by Victor Konshin on April 27, 2009 - 12:44 pm

    Sal,

    Yes, Plavix can cause gout attacks. Also, 200mg, 3 times a day sounds like Naproxen. If you are taking this dose everyday, then that is way too much. You should not take this dose for any more than 10 days and that might be too much! Does your cardiologist know you are taking NSAIDs?

    -Victor Konshin

  11. #11 by Sal C on April 28, 2009 - 3:15 pm

    Victor,
    I am not taking NSAIDs any more. My cardiologist wants me to take couple of Colchicine daily next few months to control my gout. I will follow that regiment and see. I will get your book too. Thanks for taking your time to read my posts, appreciate your help.

    Sal C

  12. #12 by jarles alberg on June 12, 2009 - 9:39 pm

    I am absolutely dumbfounded at the total disregard for allopurinol that is exibited by Doctors and anyone connected to the gout issue. I had bad gout (tofi – joint freezing etc) symptoms until my Doc put me on a regime of allopurinol. I have not had any gout since the year 2000, and no ill effects from my daily dosage of allopurinol, and I have stage 3 kidney disease. What is all the crap about diet and such about – take allopurinol and be done with gout.

  13. #13 by Bob on July 27, 2009 - 4:43 am

    I got diagnosed with gout at the age of 20. I am 26 years old now turning 27 soon. I have had lots of attacks throughout the years. At one time I did not get an attack for 2 years. But recently the newest attack was the worse. It had lasted for weeks. I don’t know what to do with my life dealing with gout and/or hyperuricima if that is what I have. I mean…I brought it on myself at the time. I was 230 pounds and did nothing but eat junk food and play video games all day and all night everyday with little movement of my body. I didn’t drink alchohol in those months of sitting on my ass doing nothing. It attacked my left foot. I thought my ankle or foot was broken somehow. I never felt pain like that other than breaking my arm skateboarding when I was younger. They took a blood test and said my uric acid levels were high and that the exray didn’t show any breakage so it was concluded it was gout. I was prescribed Volteran(dicenoflac), Vicodin and some kind of antibiotics. I am worried about kidney failure, disease and other health problems of my life. I smoke but have been cutting back on that. Any advice on my treatment besides eating healthy and exercising??

  14. #14 by Nina B. on September 27, 2009 - 3:04 am

    Hello,

    My grandfather has a very severe case of Gout- he blames most of his pain from the gout. He is currently taking allopurinol (along with a list of other medications for his chronic illnesses) to decrease his uric acid level. I heard that gout is very painful, but he also has a condition where he has very poor circulation in both of his legs below the knees. He has high blood pressure so he takes a low dosage of aspirin to thin out his blood, along with Plavix. I have two questions… 1- According to what I read above, both aspirin and Plavix are very likely to cause gout attacks- what can I suggest my grandfather to take that will help thin out his blood so he will get circulation to his legs and feet that will not increase levels of uric acid?
    2- He has been referred to many surgeons to correct his vessels but he refuses because he believes the outcome will be his feet getting amputated. His feet are always swollen with edema, dark purple, and produces an anaerobic smell. He is the patient so only he can report his symptoms; he strongly believes that his gout is the number one culprit of his misery and pain – I am just wondering if poor circulation can also be a major part of his pain and if he is not recognizing the pain from his poor circulation because he feels the majority of the pain from his gout???

  15. #15 by Kyle on January 27, 2010 - 7:51 pm

    Well I am 27 yrs old, I believe that I have gout… My first attack came less than a year ago, (was 26) when I awoke one morning to my big toes joint killing me. I thought to myself ” when did i stub my toe?”. So I limped to work, sat there for some time, and decided to go to the walk in clinic. The doctor looked at my toe and told me that it doesnt look like gout, no redness, no appearent swelling. But she did say that i was very flat footed, and that may be a reason. So i left with really no answers. Since then I have had a few morning where i woke up and my ankle would seem tender, as if a minor sprain. Didnt think nothing of it, just wondered when i sprained it. It alternated from ankle to ankle every so often. Well about 2 weeks ago I went to bed with a tender ankle, and when I woke up at 2am, I couldnt sleep because of the pain, no matter how i laid, I couldnt sleep. Woke up at 5am, and tried to walk to the shower, and it was almost impossible. I braced myself on things all the way to the bathroom. My wife had a prescription of Naproxen, so I took one, and about 3-4 hours later the pain had almost gone away completely. Well here I sit at work with my ankle begining to get tender again, and it truly depresses me because i am so young. I like my beer and football, steaks, and whatever else i like to eat, and after all of this reading, im only more upset. I guess I should go to the doc and get my uric acid lvls checked.

  16. #16 by Sara on February 25, 2010 - 5:28 pm

    Hi,
    My name is sara and I am 26 years old, recently diagnosed with gout. I am about 30 pounds over weight, don’t drink, and eat very little meat. I have had 6-7 attacks in the last 2 years. My ankle swells, has a fever, and is extremely painful. The doctor tested my uric acid levels during my last attack and they came back fine, 3.8 I believe. They still diagnosed me with gout, gave me a prescription for indocin and said to wrap it with an ace bandage. I am left feeling very aggrevated. They told me to see a rhumatologist if I wanted to find out why. But the nurse acted like I was being a pain for not being satisfied with a diagnoses but wanting a reason or an explanation. I have decided to wait until my next attack and see if I can get into the rhumatologist. The only problem is my attacks only last about a week and I never know when they are coming I wake up one morning and my ankle is huge. This last for about a week and then wake up and it is better, without any treatment. Any input would be appreciated.
    Thanks,
    Sara

  17. #17 by Kelsey on March 18, 2010 - 3:15 pm

    Hi, I’ve been looking for different articles about Gout and I’ve found this very helpful. I was recently diagnosed with Gout. I am currently 19 and female. Everything I have read says this is very uncommon. This is my first attack and has been very painful. It happened in my toes, not my big toe but in my little toes. I haven’t been able to find anything to explain why and how I got this.
    I have a family history of Diabetes in my family and I myself have high blood sugars. I have been tested for Diabetes and tested negative. I have a meter and check sometimes. It usually runs 100 or higher. And I was wondering if maybe this could be why I have got it or has something to do with it?

  18. #18 by shane on September 9, 2010 - 5:36 pm

    Hi, I was diagnosed with gout about a year ago. I am a forty year old man. I have had probably 7 extremely painful attacks in the last year and the last one has caused both my arm muscles to ache along with the extremely painful big toe my knuckle joints are also hurting. Should I be concerned with the arm pain it seems to be extremely deep in the bones almost the big toe is the place I usually get it in. I have never taken any medication and have trying the black cherry and blueberry approach. My grandfather had gout also and he just did as I am doing lived with the pain. Any advise would be great. Thanks SHane

  19. #19 by Jack Clark on December 4, 2010 - 6:47 am

    Im also 22 years of age and had my first attack in May 2010. Since then ive had 6 major attacks, but the worst thing is, it never goes away. ive always got it. The swelling goes away but the pain is still there. Ive been to see a couple of docters, im just on naproxen and paracetamol. Im just at a wits end. I cant cope with it any more! im 22 for goodness sake! its ridiculas! i dont want to take a pill for the rest of my life but im worried that something else is going on really. Im a fit guy, play rugby 3 times a week, so i am heavy,nearly 100kgs. im also quite short, 175cm. However, this shouldnt have any effect surley, like i said, i play sports and stay away from garlic, onions, red meat etc.
    Please can you help me?
    Jack

  20. #20 by Rahul K on December 10, 2010 - 7:07 am

    My age is 36 years. I have been suffering from gout since last 10 years (one to two attacks per year on approximate basis. I have recently been diagnosed with Coronary Artery Disease (2 years ago) and had undergone angioplasty (2 times-3 stents). Life has become miserable, I feel depressed and had spent lot of money on my disease, I am taking ecospirin, plavix for heart and one allupurinol daily for gout. My advice for gout patients is to take care of your heart, manage gout properly, avoid taking NSAIDS for long term basis. I think, apple is the natural pain killer during gout attacks, go on pure apple diet for 2-4 days, drink cider apple vinegar, this helps for me. My problem which I feels contributes to gout is eating junk food, not drinking adequate water etc.
    Thanks

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