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Five Conditions Linked With Gout

High uric acid levels are associated with problems besides painful joints. If you have gout, you may be at greater risk.

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When you think of gout, your first thought may be that of an excruciatingly painful and swollen big toe that makes it difficult to wear a shoe or sock or even endure the weight of a bed sheet. But if you’ve experienced gout attacks, it’s important to see your doctor regularly for more reasons than relieving pain or preventing further attacks of joint inflammation, says Eswar Krishnan, MD, a Los Angeles area rheumatologist and noted expert in gout.

Research by Dr. Krishnan and others is showing that gout is associated with a number of health problems. In most cases the common culprit is high blood levels of uric acid. The same substance that seeps out of the blood and forms as crystals that inflict pain in your big toe and other joints may also affect your kidneys, blood vessels or other organs.

Consequently managing uric acid levels through diet, exercise and medication could potentially help these other problems or reduce your risk of developing them in the first place.

If you have gout, speak with your doctor about the following:

1. Kidney stones and kidney disease

Kidney stones are one of the most common uric acid-related problems, affecting an estimated 1 in 5 people with gout. Just as joint pain occurs when uric acid crystals deposit in the joints, kidney stones occur when uric acid crystals deposit in the kidneys and block the urinary tract. If left untreated, kidney stones can cause kidney infections and damage.

Kidney disease, ranging from reduced function to complete kidney failure, can also occur with gout separate from kidney stones. Kidney disease may either lead to gout – if damage to the kidneys inhibits their ability to filter uric acid – or result from gout -- if uric acid crystals damage the kidneys. In a 2013 study published in Arthritis & Rheumatism, Dr. Krishnan examined health data of 12,866 men between the ages of 35 and 57. He found that those with kidney disease were about 60 percent more likely to have gout than those without.

2. Diabetes

Diabetes occurs when insufficient production of insulin or a lack of response to insulin allows high levels of sugar to build in the blood. Uncontrolled diabetes can damage the eyes, kidneys and nerves and blood vessels.

In a study published in 2016 in the Annals of the Rheumatic Diseases, researchers who examined data of more than 172,000 people from an electronic records database representative of the general UK population found that the risk of diabetes – particularly for women – was greater for those with gout. In fact, women with gout were 71 percent more likely to develop diabetes; for men, gout risk increased by 22 percent.

The research doesn’t explain how gout might increase diabetes risk; however, the authors suspect low-level inflammation from gout – as well as common risk factors including high cholesterol and high blood pressure – may play a role.

3. Sleep apnea

Sleep apnea is a disorder characterized by frequent pauses in breathing, which can last from a few seconds to a minute or more, during sleep. In addition to disrupting sleep, untreated sleep apnea can increase the risk of obesity, diabetes, high blood pressure, heart attack and stroke.

In a 2015 study published in Arthritis & Rheumatism, researchers studied 9,865 people with gout and 43,598 controls from a large UK database. They found that after one year, people with gout, compared the controls, were 50 percent more likely to have a gout attack. The authors note that pauses in breathing cause periods of oxygen deprivation, which trigger uric acid to be overproduced in the blood – the cause of gout.

4. Cardiovascular disease

High levels of uric acid – and its potential effects on the blood vessels – have been linked to a higher risk of cardiovascular problems. In a study published in the British Medical Journal in 2013, Dr. Krishnan examined data from 4,989 members of the Framingham Offspring Study. He found that participants with gout had two to three times higher incidence of clinical heart failure and echocardiographic measures of systolic dysfunction – impaired ability of the heart’s ventricals to contract -- compared with those without. Mortality was elevated in subgroup of patients with gout and heart failure compared to those with heart failure but without gout.

A separate study from Boston University, published in 2010 in the Annals of the Rheumatic Diseases, found that women with gout have about a 39 percent greater chance of having a heart attack – or 41 percent greater chance of having a non-fatal heart attack -- than women without gout. The increased risk was significantly than that for men.

5. Cancer

In a 2015 study, which examined data from more than two million residents of a single Swedish county, researchers found that women with gout were 32 percent more likely and men were 13 percent more likely than those without gout to have malignancies.

In a separate 2012 study published in Joint Bone Spine, Taiwanese researchers examined the association between gout and malignancy using data from the National Health Insurance Database of Taiwan. They found gout is associated with a significantly increased risk of certain cancers, particularly prostate cancer in men. Interestingly, women with gout had a slightly reduced risk of breast cancer.

Increasingly research is showing that having gout may mean more than having to endure more than painful attacks of joint inflammation. “In my studies it became clear to me that gout is not a benign disease,” says Dr. Krishnan, who says he wished to understand the extent and depth and of the link between gout and comorbidities.

He says anyone who has gout should be aware of the link and speak with their doctor. “The first attack of gout should be a wake-up call to anyone,” Dr. Krishnan says. “Regardless of the urate concentration, severity, frequency or extent, the first attack of gout should prompt a complete health and health risk evaluation, lifestyle reassessment and, in the case of men and women younger than 50, a complete renal assessment.”

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