Secondary Gout


For the overwhelming majority of people with gout (90%), gout is a genetic disease.  These cases are called primary gout.  In this article will talk about the other 10% – what is called secondary gout.  There is a very long list of causes of secondary gout.  Here I will talk about the most common and the most serious.

Lifestyle

The single most common cause of secondary gout are lifestyle issues.  Lifestyle covers a lot of different areas.  Unfortunately, one of the most common is obesity.  About 60% of Americans are now considered obese and the number is still growing and is the leading reason why the incidence of gout continues to rise.  Being overweight causes the body to create more uric acid but also reduces the bodies ability to eliminate uric acid.  If you have gout and are overweight, the single best thing you can do for your gout, and for your overall health, is to eat a healthy, well balanced, reduced calorie diet, lose weight and exercise regularly (See “The ‘Skinny’ on Gout Diets”).  Of course everyone that is overweight wants to do this but few people are actually successful, myself included.


Another lifestyle factor is alcohol consumption.  Alcohol also causes the body to produce more uric acid and reduces the body’s ability to remove it but alcohol is also a diuretic, which means that it causes the body to lose water.  This results in an increase in the concentration of uric acid in the body and an increase in the risk of gout.  You should know by now that beer is very bad for gout.  On top of the alcohol, there is something else in beer that causes uric acid to rise.

Historically it was thought that the purines in beer where the culprit but modern beers have very low purine levels compared to other foods with a low gout risk so there is something else in beer that makes it so bad.  As a side note, if happen to own a brewery, you could make a fortune if you found out what what it is in beer that causes gout and create a “gout friendly” beer.  There is nothing that inspires grumbling from a gout sufferer more than telling them that they can’t drink beer.

Interestingly, wine has been shown to slightly lower the risk of gout if you drink one glass per day.  This suggests that there is something in wine that causes uric acid levels to go down.  However, after two glasses per day the alcohol over powers this effect and the risk goes back up.

Another possible cause of secondary gout is a poor diet.  If you live on a diet of fast food and soft drinks you are asking for trouble.  High intakes of meat proteins have been shown to increase the risk of gout.  But high-fructose corn syrup and other sugars, are probably one of the most powerful means of increasing uric acid levels.  There is a fascinating and complex relationship between sugar and uric acid.  Unfortunately, it seems everything we eat has sugar or high-fructose corn syrup added particularly drinks such as soft drinks.

If you have been reading my other posts, you might be thinking, “hey, you said diet doesn’t cause gout.”  Well, actually, what I said was that for most of us, you cannot control gout with diet alone.  If your gout is caused by genetic, then changing your diet will will usually not fix the problem.  However, if your gout is the result of obesity, abuse of alcohol or abuse of high-fructose corn syrup or other sweets, then you are in the very small minority of “curable” gout cases.  That is, if you can make the changes to your diet and lifestyle that are needed…

Metabolic Syndrome

Metabolic Syndrome is not a disease but a set of conditions that are a catalyst for diseases such as heart disease, diabetes, stroke and several types of cancer. It is defined as having three or more of the following conditions:

  • Elevated Waist Circumference: If your waist line is more than 40 inches (102cm) for man or 35 inches (88cm) for woman, you have an “elevated waist circumference”.
  • Elevated Triglycerides: If your triglycerides are more than 150md/dL (8.33mmols/L) or you are on medication to control them, then they are elevated.
  • Reduced HDL or “Good” Cholesterol: If your HDL cholesterol is less than 40mg/dL (2.22mmol/L) for men or 50mg/dL (2.77mmols/L) for woman or you are on medication to treat low HDL cholesterol, you’ve got this one.
  • Elevated Blood Pressure: If your blood pressure is over 130/85 or you are on medication to control your blood pressure, you can put a check next to this one.  Also, keep reading, some high blood pressure medications can increase uric acid levels.
  • Elevated Fasting Glucose: If your fasting glucose level is more than 100mg/dL (5.55mmols/L) or you are on medication to reduce glucose levels, then this is another strike.

The connection between Metabolic syndrome and gout is not fully understood but we do know is that 75% of people with gout also have Metabolic syndrome compared to 25% that do not have gout.  It seems that they work hand in hand and result in a much higher risk of a lot of very dangerous diseases.  To prevent Metabolic syndrome, you need to use a system that should sound very familiar by now: eat a healthy, balanced and reduced calorie diet (For a diet designed specifically for Metabolic syndrome, See “The ‘Skinny’ on Gout Diets”), reduce your weight to a health level and exercise regularly.   Sound familiar?

Kidney problems

About two thirds of the uric acid that is removed from the body is removed by the kidneys.  Therefore, if you have kidney problems, there is a good chance that you will not be able to filter out uric acid quickly enough to avoid it building up.  Any decent doctor will check your kidney function on a regular basis, but if you have recently been diagnosed with gout, it wouldn’t be a bad idea to ask your doctor to give you kidneys a closer look.  Also, if you have primary gout, uric acid is very hard on the kidneys.  One study showed that 99% of people with gout had significant kidney damage at the time of death.  Take care of your kidneys.

Medications and Vitamins

Diuretics, which are commonly used to treat high blood pressure, can significantly raise uric acid levels. Also medications to used with organ transplants, to treat psoriasis, heart failure, tuberculosis and Parkinson’s disease can increase uric acid levels.  Niacin, more commonly known as vitamin B3 can also increase uric acid levels.  Lastly, low-dose aspirin therapy can also increase uric acid levels and the risk of gout.

Severe Psoriasis

Psoriasis is a condition where the immune system attacks the skin and joints.  We know that cell death causes the release of many substances that the body metabolizes into uric acid so when the body attacks the skin and other tissues as in psoriasis, many cells are killed and uric acid levels rise.  Effectively managing the psoriasis should allow uric acid levels to return to normal.  Also, the drug ciclosporin is often used to treat psoriasis however, this medication can significantly increase uric acid levels and the risk of gout.

Sleep Associated Hypoxemia or Sleep Apnea

Sleep apnea causes a deprivation of oxygen which can result in cell death and raised uric acid levels.  Unfortunately, there is little research on this topic and none that looks at the relationship between sleep apnea and gout directly.  Regardless, this may be a common and unrecognized secondary cause of hyperuricemia and gout.

Cancer

Some types of cancer have been associated with hyperuricemia and gout, particularly cancers of the bone or bone marrow.  If you have recently been diagnosed with gout and have none of the risk factors and have no family history of gout, then you might want to ask your doctor about this as a possible secondary cause.  Though rare, this is probably one of the most deadly secondary causes of gout.

Lead Poisoning

If you live in an old house with peeling paint, work in a trade that regularly exposes you to lead or just think paint chips are just so darn tasty, then your gout might be caused by lead poisoning.  Lead poisoning targets the kidneys and as you should know by now that the kidneys are the major route out of the body for uric acid.  If you suspect lead poisoning, there are effective treatments and you should discuss this with your doctor.

Pre-Eclampsia

This common complication of pregnancy can result in a spike in uric acid levels and result in gout.  It is extremely uncommon for women to have hyperuricemia or gout before menopause because estrogen plays a powerful role in controlling uric acid levels.  So if and you are pregnant and develop gout, then you should discuss this with your doctor right away.  If you are a man and are pregnant, you should call the media right way.

Other Causes of Secondary Gout

There is a long list of other reasons.  In my book, Beating Gout, I give a nearly two page long list and even that list is not complete.  If you have no family history of gout or any of the lifestyle factors described above but still have hyperuricemia, then you should have a long talk with your doctor about possible secondary causes.


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  1. #1 by Simon on January 12, 2011 - 9:14 am

    Hi Victor

    In your opinion does hyperuricemia cause the symptoms of metabolic syndrome or does having metabolic syndrome cause hyperuricemia? Does it also follow that if the former is the case then alluprinol would in effect “cure” metabolic syndrome, and if the latter is the case then diet and exercise would “cure” hyperuricemia, thereby negating he requirement for alluprinol?

    What are your thoughts?

    Regards
    Simon

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