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:
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.
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